1275549412 NPI number — MICHELLE R MCCARTY MS, OTR/L, CHT CEAS

Table of content: MICHELLE R MCCARTY MS, OTR/L, CHT CEAS (NPI 1275549412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275549412 NPI number — MICHELLE R MCCARTY MS, OTR/L, CHT CEAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCARTY
Provider First Name:
MICHELLE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, OTR/L, CHT CEAS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCARTY
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1275549412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6707 N RIVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLE RIVER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21220-1033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-933-0897
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 NEWPORT DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST HILL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21050-1758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-838-6808
Provider Business Practice Location Address Fax Number:
410-838-2511
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  05712 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 382617193 . This is a "TAX IDENFICATION NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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