Provider Demographics
NPI:1376973503
Name:HALBERDA, MICHELE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:HALBERDA
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 1:2615 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-1215
Mailing Address - Country:US
Mailing Address - Phone:412-654-6426
Mailing Address - Fax:
Practice Address - Street 1:625 S WAKEFIELD ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1480
Practice Address - Country:US
Practice Address - Phone:412-654-6426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06197225XP0200X
VA0119006704225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119006704OtherVIRGINIA BOARD OF MEDICINE OT LICENSE
MD06197OtherMARYLAND STATE OCCUPATIONAL THERAPY LICENSE