Provider Demographics
NPI:1992576185
Name:ROBERTSON, MICHAELA MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:MARIE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7359 MEADOWGOLD DR
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-7613
Mailing Address - Country:US
Mailing Address - Phone:937-707-5726
Mailing Address - Fax:
Practice Address - Street 1:7359 MEADOWGOLD DR
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-7613
Practice Address - Country:US
Practice Address - Phone:937-707-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT013138225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist