Provider Demographics
NPI:1275549412
Name:MCCARTY, MICHELLE R (MS, OTR/L, CHT CEAS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:MS, OTR/L, CHT CEAS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MCCARTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6707 N RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1033
Mailing Address - Country:US
Mailing Address - Phone:410-933-0897
Mailing Address - Fax:
Practice Address - Street 1:12 NEWPORT DR STE A
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-1758
Practice Address - Country:US
Practice Address - Phone:410-838-6808
Practice Address - Fax:410-838-2511
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05712225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD382617193OtherTAX IDENFICATION NUMBER
MD216512Medicare ID - Type Unspecified