Provider Demographics
NPI:1598351322
Name:MICHAUD, JESSE (MOT,OTR,L,CLT,WCC)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:MICHAUD
Suffix:
Gender:M
Credentials:MOT,OTR,L,CLT,WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04274-6371
Mailing Address - Country:US
Mailing Address - Phone:207-567-7381
Mailing Address - Fax:
Practice Address - Street 1:42 SANDERSON RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:ME
Practice Address - Zip Code:04274-6371
Practice Address - Country:US
Practice Address - Phone:207-567-7381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2465225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist