Provider Demographics
NPI:1619183373
Name:BOMBICO, MICHELLE JOANNA (OTR)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JOANNA
Last Name:BOMBICO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 SHADE TREE PL APT B
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1866
Mailing Address - Country:US
Mailing Address - Phone:410-869-8351
Mailing Address - Fax:
Practice Address - Street 1:9801 BROKENLAND PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3080
Practice Address - Country:US
Practice Address - Phone:410-290-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist