Provider Demographics
NPI:1093280216
Name:TROUP, MICHELLE JACQUELINE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JACQUELINE
Last Name:TROUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22030 BOCA PLACE DR APT 627
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8006
Mailing Address - Country:US
Mailing Address - Phone:574-527-3681
Mailing Address - Fax:
Practice Address - Street 1:3275 W HILLSBORO BLVD STE 210
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9476
Practice Address - Country:US
Practice Address - Phone:954-428-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17250225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist