Provider Demographics
NPI:1427834340
Name:MA, MICHELE (OTD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 PLEASANT ST APT 321
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4855
Mailing Address - Country:US
Mailing Address - Phone:617-331-6920
Mailing Address - Fax:
Practice Address - Street 1:4 MILITIA DR STE 18
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4714
Practice Address - Country:US
Practice Address - Phone:781-861-0695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15036225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist