Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | MA |
NPI | 1003442856 |
---|---|
Provider Name | Michelle Mary Beaulieu |
First Address | Louisville, KY 40299-6395 |
Second Address | Athol, MA 01331-6903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2020 |
Last Update Date | 12/03/2020 |