Provider Demographics
NPI:1295038578
Name:SMITH, MICHELE ANTOINETTE
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANTOINETTE
Last Name:SMITH
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 1:1211 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-4603
Mailing Address - Country:US
Mailing Address - Phone:781-803-2109
Mailing Address - Fax:
Practice Address - Street 1:1211 AVALON DR
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-4603
Practice Address - Country:US
Practice Address - Phone:781-803-2109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor