Provider Demographics
NPI:1659492015
Name:COLLINS, MICHELLE L (OTRL)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:COLLINS
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 1:3315 ERIK CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2311
Mailing Address - Country:US
Mailing Address - Phone:202-251-1175
Mailing Address - Fax:
Practice Address - Street 1:3315 ERIK CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2311
Practice Address - Country:US
Practice Address - Phone:202-251-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05257225X00000X
DC225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist