Provider Demographics
NPI:1780906735
Name:RUTLEDGE, MICHELLE RUTHANN (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RUTHANN
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WALDEMAR CT SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3830
Mailing Address - Country:US
Mailing Address - Phone:863-326-6197
Mailing Address - Fax:
Practice Address - Street 1:701 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-1671
Practice Address - Country:US
Practice Address - Phone:863-206-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA8498224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant