Healthcare Provider Details

I. General information

NPI: 1376973503
Provider Name (Legal Business Name): MICHELE HALBERDA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S WAKEFIELD ST
ARLINGTON VA
22204-1480
US

IV. Provider business mailing address

2615 3RD ST N
ARLINGTON VA
22201-1215
US

V. Phone/Fax

Practice location:
  • Phone: 412-654-6426
  • Fax:
Mailing address:
  • Phone: 412-654-6426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number06197
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119006704
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: