Provider Demographics
NPI:1417638453
Name:OTTOBRE, MICHELLE ROSE (OTA/L, CDP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROSE
Last Name:OTTOBRE
Suffix:
Gender:F
Credentials:OTA/L, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-2515
Mailing Address - Country:US
Mailing Address - Phone:732-425-0973
Mailing Address - Fax:
Practice Address - Street 1:515 CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-2515
Practice Address - Country:US
Practice Address - Phone:727-934-4629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17515224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant