Healthcare Provider Details

I. General information

NPI: 1003009820
Provider Name (Legal Business Name): MICHELLE ANDRE BARBAGALLO O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 NEW PROVIDENCE RD
MOUNTAINSIDE NJ
07092-2590
US

IV. Provider business mailing address

520 FOOTHILL RD
BRIDGEWATER NJ
08807-2236
US

V. Phone/Fax

Practice location:
  • Phone: 908-233-3720
  • Fax:
Mailing address:
  • Phone: 908-429-9856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR00009400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: