Provider Demographics
NPI:1497091268
Name:HAY, MICHELLE L (LMT,CMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:HAY
Suffix:
Gender:F
Credentials:LMT,CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 LAKE AVE
Mailing Address - Street 2:1
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-3850
Mailing Address - Country:US
Mailing Address - Phone:631-680-0293
Mailing Address - Fax:
Practice Address - Street 1:521 LAKE AVE
Practice Address - Street 2:1
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-3850
Practice Address - Country:US
Practice Address - Phone:631-680-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-22
Last Update Date:2012-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59565225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist