Provider Demographics
NPI:1598002800
Name:POTTINGER, MICHELLE JANESE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:JANESE
Last Name:POTTINGER
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 1:46112 THOROUGHBRED WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-2069
Mailing Address - Country:US
Mailing Address - Phone:240-431-2459
Mailing Address - Fax:855-494-1574
Practice Address - Street 1:1875 CANDLELIGHT CT
Practice Address - Street 2:
Practice Address - City:OWINGS
Practice Address - State:MD
Practice Address - Zip Code:20736-3616
Practice Address - Country:US
Practice Address - Phone:410-921-6846
Practice Address - Fax:855-494-1574
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07593225X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty