Healthcare Provider Details

I. General information

NPI: 1598002800
Provider Name (Legal Business Name): MICHELLE JANESE POTTINGER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 CANDLELIGHT CT
OWINGS MD
20736-3616
US

IV. Provider business mailing address

46112 THOROUGHBRED WAY
LEXINGTON PK MD
20653-2069
US

V. Phone/Fax

Practice location:
  • Phone: 410-921-6846
  • Fax: 855-494-1574
Mailing address:
  • Phone: 240-431-2459
  • Fax: 855-494-1574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number07593
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: