Provider Demographics
NPI:1508293119
Name:FITZGERALD, MICHELLE (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E WYNNEWOOD RD
Mailing Address - Street 2:APT 18L
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-1547
Mailing Address - Country:US
Mailing Address - Phone:484-683-5081
Mailing Address - Fax:
Practice Address - Street 1:150 E WYNNEWOOD RD
Practice Address - Street 2:APT 18L
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-1547
Practice Address - Country:US
Practice Address - Phone:484-683-5081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOCO11326225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics