Healthcare Provider Details

I. General information

NPI: 1801883376
Provider Name (Legal Business Name): MICHAEL J URBAN OTD, MBA, OTRL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BARKLEDGE CT
CHESHIRE CT
06410-3059
US

IV. Provider business mailing address

90 BARKLEDGE CT
CHESHIRE CT
06410-3059
US

V. Phone/Fax

Practice location:
  • Phone: 203-915-5643
  • Fax: 203-303-9600
Mailing address:
  • Phone: 203-915-5643
  • Fax: 203-303-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number002838
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: