Provider Demographics
NPI:1710383450
Name:HENDRIXON, MICHAELANNE (AT, ATC)
Entity Type:Individual
Prefix:
First Name:MICHAELANNE
Middle Name:
Last Name:HENDRIXON
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3566 W WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:MI
Mailing Address - Zip Code:49437-8453
Mailing Address - Country:US
Mailing Address - Phone:231-894-2608
Mailing Address - Fax:
Practice Address - Street 1:3566 W WEBSTER RD
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:MI
Practice Address - Zip Code:49437-8453
Practice Address - Country:US
Practice Address - Phone:231-894-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010001532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer