Provider Demographics
NPI:1598186512
Name:SCHWARTZ, MICHELE (OTR)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:GAETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1922 LAKE ROBERTS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5579
Mailing Address - Country:US
Mailing Address - Phone:269-599-1192
Mailing Address - Fax:
Practice Address - Street 1:1922 LAKE ROBERTS LANDING DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5579
Practice Address - Country:US
Practice Address - Phone:269-599-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16077225XP0200X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010427900Medicaid
FL010613900Medicaid