Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1720193337 |
---|---|
Provider Name | Mrs. Kim Michaud |
First Address | Vassalboro, ME 04989-3230 |
Second Address | Augusta, ME 04330-6719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CFO01953 | ABC CERFITICATION (01) |