Provider Demographics
NPI:1043235294
Name:MCLEMORE, MICHELLE MILLER (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MILLER
Last Name:MCLEMORE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:MICHELLE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:526 OLD STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-3200
Mailing Address - Country:US
Mailing Address - Phone:803-243-9978
Mailing Address - Fax:
Practice Address - Street 1:1007 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4211
Practice Address - Country:US
Practice Address - Phone:803-432-1478
Practice Address - Fax:803-432-4212
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2604225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist