Provider Demographics
NPI:1801883376
Name:URBAN, MICHAEL J (OTD, MBA, OTRL)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:URBAN
Suffix:
Gender:M
Credentials:OTD, MBA, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BARKLEDGE CT
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3059
Mailing Address - Country:US
Mailing Address - Phone:203-915-5643
Mailing Address - Fax:203-303-9600
Practice Address - Street 1:90 BARKLEDGE CT
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3059
Practice Address - Country:US
Practice Address - Phone:203-915-5643
Practice Address - Fax:203-303-9600
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002838225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist