Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 225X00000X | Occupational Therapist | 137212 | AK |
NPI | 1003136219 |
---|---|
Provider Name | Carolyn Michaud |
First Address | Fairbanks, AK 99701-7530 |
Second Address | Anchorage, AK 99508-5364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2010 |
Last Update Date | 20/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MH0157 | (05) | AK |