Healthcare Provider Details

I. General information

NPI: 1629923537
Provider Name (Legal Business Name): MICHAELLA RUTH ISRAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 DARTMOUTH ST
MALDEN MA
02148-5103
US

IV. Provider business mailing address

82 GRANT ST
SOMERVILLE MA
02145-1928
US

V. Phone/Fax

Practice location:
  • Phone: 781-306-4820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTL36851
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: