Provider Demographics
NPI:1821284837
Name:STAUDENMAIER, MICHELE K (OTLR)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:K
Last Name:STAUDENMAIER
Suffix:
Gender:F
Credentials:OTLR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 PAGNOTTA PL
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-8046
Mailing Address - Country:US
Mailing Address - Phone:919-449-7460
Mailing Address - Fax:
Practice Address - Street 1:5305 PAGNOTTA PL
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8046
Practice Address - Country:US
Practice Address - Phone:919-449-7460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15491225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics