Provider Demographics
NPI:1518566116
Name:KLOTZMAN, MICHAL YAEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:YAEL
Last Name:KLOTZMAN
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 1:3403 TANEY RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3729
Mailing Address - Country:US
Mailing Address - Phone:443-987-6594
Mailing Address - Fax:
Practice Address - Street 1:145 W OSTEND ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-3764
Practice Address - Country:US
Practice Address - Phone:443-225-7215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09028225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation