Healthcare Provider Details

I. General information

NPI: 1497600183
Provider Name (Legal Business Name): MICHALA ANGEL CONNOR LE, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 ELLICOTT MILLS DR STE B1
ELLICOTT CITY MD
21043-4599
US

IV. Provider business mailing address

3505 ELLICOTT MILLS DR STE B1
ELLICOTT CITY MD
21043-4599
US

V. Phone/Fax

Practice location:
  • Phone: 443-203-8308
  • Fax:
Mailing address:
  • Phone: 443-203-8308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM07026
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: