Provider Demographics
NPI:1346638012
Name:GORMAN, MICHELLE C (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:GORMAN
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 1:101 S BRYN MAWR AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3120
Mailing Address - Country:US
Mailing Address - Phone:610-525-1000
Mailing Address - Fax:610-525-1001
Practice Address - Street 1:101 S BRYN MAWR AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3120
Practice Address - Country:US
Practice Address - Phone:610-525-1000
Practice Address - Fax:610-525-1001
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013750225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist