MICHELLE A PETAK (NPI# 1104484179) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104484179 |
| Entity Type | Individual |
| Full Name | MICHELLE A PETAK |
| Practice Address |
12616 Sharon Lynn Dr Salem OH 44460-9134 |
| Mailing Address |
2000 Noble Dr Wooster OH 44691-5353 |
| Practice Telephone | 3303377732 |
| Mailing Telephone | 3302643232 |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2019-06-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
12616 SHARON LYNN DR |
| City | SALEM |
| State | OH |
| Zip Code | 44460-9134 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508963216 | Sharon Lynn Dragovich | Clinical Nurse Specialist | 12616 Sharon Lynn Dr, Salem, OH 44460-9134 | 2006-09-17 |
| 1003421652 | Daniel Koehler | Case Manager/Care Coordinator | 12616 Sharon Lynn Dr, Salem, OH 44460-9134 | 2020-09-10 |
| 1497363006 | Kiah S Powell | Case Manager/Care Coordinator | 12616 Sharon Lynn Dr, Salem, OH 44460-9134 | 2020-07-20 |
| 1619585759 | Sha'wanda Pargo | Case Manager/Care Coordinator | 12616 Sharon Lynn Dr, Salem, OH 44460-9134 | 2020-07-15 |
| 1124659461 | Erin Gilmore | Licensed Practical Nurse | 12616 Sharon Lynn Dr, Salem, OH 44460-9134 | 2020-01-27 |
| 1760029490 | Jacinta Taylor | Case Manager/Care Coordinator | 12616 Sharon Lynn Dr, Salem, OH 44460-9134 | 2019-12-02 |
| 1619520095 | Yalonda M Robinson | Case Manager/Care Coordinator | 12616 Sharon Lynn Dr, Salem, OH 44460-9134 | 2019-07-24 |
| 1477114759 | Alicia Royer | Case Manager/Care Coordinator | 12616 Sharon Lynn Dr, Salem, OH 44460-9134 | 2019-06-26 |
| 1316508971 | Tina L Workman | Counselor | 12616 Sharon Lynn Dr, Salem, OH 44460-9134 | 2019-06-25 |
| 1710542188 | Amanda Mcclimans | Case Manager/Care Coordinator | 12616 Sharon Lynn Dr, Salem, OH 44460-9134 | 2019-05-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972155257 | Action Physical Therapy and Rehabilitation, Inc | Physical Therapy Assistant | 2311 East State Street, Salem, OH 44460 | 2019-07-16 |
| 1851855563 | Jessica Michelle Adkins | Occupational Therapy Assistant | 100 Blossom Ln, Salem, OH 44460 | 2019-01-27 |
| 1699266981 | Morgan Nicole Shivers | Dentist | 2951 Oh-45, Salem, OH 44460 | 2018-05-23 |
| 1518466580 | Continental II Leasing Co., LLC | Skilled Nursing Facility | 230 Continental Drive, Salem, OH 44460 | 2018-02-06 |
| 1447759410 | Continental I Leasing Co., LLC | Skilled Nursing Facility | 250 Continental Drive, Salem, OH 44460 | 2018-02-06 |
| 1912405648 | Ascend Home Health Care LLC | Home Health | 1367 Slater Rd, Salem, OH 44460 | 2018-01-29 |
| 1225562572 | Melissa Sue Chadbourne | Occupational Therapist | 7855 Pleasant Valley Ct, Salem, OH 44460 | 2017-04-13 |
| 1104274489 | Dakota Deamicis | Specialist/Technologist | 7777 W. Middletown Rd, Salem, OH 44460 | 2016-05-27 |
| 1811312028 | Denise Repella | Speech-Language Pathologist | 1171 Hampton Pl, Salem, OH 44460 | 2014-02-25 |
| 1750702338 | Care4me Skilled, LLC | Home Health | 2400 Southeast Blvd., Suite B, Salem, OH 44460 | 2013-12-26 |
| Find all providers in zip 44460 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336755586 | Emma Theresa Cox | Case Manager/Care Coordinator | 33 Upham St Apt 3, Salem, MA 01970-2460 | 2020-09-22 |
| 1407475064 | Yolanda Loyer | Case Manager/Care Coordinator | 2789 E State St Ste 7, Salem, OH 44460-9327 | 2020-04-14 |
| 1770121501 | Stacy Bush Phillips | Case Manager/Care Coordinator | 1501 Mill Race Dr, Salem, VA 24153-3137 | 2019-12-11 |
| 1528618659 | Linda Diane Pierce | Case Manager/Care Coordinator | 1724 Broadway St Ne, Salem, OR 97301-0509 | 2019-09-20 |
| 1770002271 | Traci L Lee | Case Manager/Care Coordinator | 3876 Beverly Ave Bldg G, Salem, OR 97305 | 2017-09-15 |
| 1427576065 | Katherine Lingmai | Case Manager/Care Coordinator | 1790 23rd St. Ne, Salem, OR 97301 | 2017-09-04 |
| 1225577240 | Anjalique Benham | Case Manager/Care Coordinator | 5 Lancelot Ct, Apt#1, Salem, NH 03079-3555 | 2017-02-23 |
| 1518409762 | Melissa Ward | Case Manager/Care Coordinator | 1380 Southside Dr, Suite 100, Salem, VA 24153 | 2016-11-04 |
| 1467810945 | Carl Walton Kapocias | Case Manager/Care Coordinator | 750 Front St Ne, Salem, OR 97301-1089 | 2016-01-29 |
| 1215339361 | Kaylor Ficklin | Case Manager/Care Coordinator | 188 E 300 S, Salem, UT 84653-9453 | 2014-09-19 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.