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General NPI Number Information
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NPI Number | 1679236608
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Entity Type | Organization
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Legal Business Name | MY VIRTUAL VITALITY, LLC
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Dates
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Enumeration Date | 10/17/2021
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 6123 BURNT OAK RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-2730
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Country | US
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Telephone | 434-989-8744
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Fax |
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Provider Business Mailing Address
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Address Line | 6123 BURNT OAK RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-2730
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER AND OCCUPATIONAL THERAPIST
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Name | MICHELLE YENTSCH
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Credential | OTR/L, FMCHC
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Telephone | 434-989-8744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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