Provider Demographics
NPI:1073522231
Name:MCLEOD, MICHELLE M (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 BPW CLUB RD
Mailing Address - Street 2:APT F10
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2589
Mailing Address - Country:US
Mailing Address - Phone:319-230-8115
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HL
Practice Address - Street 2:FETZER GYMNASIUM
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-8700
Practice Address - Country:US
Practice Address - Phone:919-962-2067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1141OtherNC STATE LICENSURE