Provider Demographics
NPI:1306116249
Name:MCCLOSKEY, MICHELLE (OT/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCCLOSKEY
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25480 POINT LOOKOUT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-3801
Mailing Address - Country:US
Mailing Address - Phone:240-256-3711
Mailing Address - Fax:
Practice Address - Street 1:25480 POINT LOOKOUT RD STE 200
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3801
Practice Address - Country:US
Practice Address - Phone:240-256-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2653225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist