Provider Demographics
NPI:1598828519
Name:MICHAEL, MARIA (OTRL)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 WISTERIA LN
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2506
Mailing Address - Country:US
Mailing Address - Phone:251-978-1280
Mailing Address - Fax:251-970-3233
Practice Address - Street 1:21040 MIFLIN RD STE 2
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:251-978-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0828225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51099356OtherBCBS PROVIDER NUMBER
AL529917620Medicaid
AL1003819608OtherGROUP NPI
AL1003819608OtherGROUP NPI