Basic Information
| Provider Information | |||||||||
| NPI: | 1114489630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESANTIS | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9920 PEPPER HILL RD | ||||||||
| Address2: | |||||||||
| City: | PERRY HALL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211289772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438048987 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8401 LEEFIELD RD | ||||||||
| Address2: | |||||||||
| City: | PARKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212343817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108875378 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2019 | ||||||||
| LastUpdateDate: | 04/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 05086 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.