Provider Demographics
NPI:1508221599
Name:PEARSON, MICHELE DAWN (OT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:DAWN
Last Name:PEARSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:GIBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54 RIVER GROVE
Mailing Address - Street 2:BOX 395
Mailing Address - City:SANFORD
Mailing Address - State:MANITOBA
Mailing Address - Zip Code:R0G 2J0
Mailing Address - Country:CA
Mailing Address - Phone:204-479-0959
Mailing Address - Fax:
Practice Address - Street 1:5419 N LOVINGTON HWY
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9100
Practice Address - Country:US
Practice Address - Phone:575-492-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3459225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist