Provider Demographics
NPI:1720193337
Name:MICHAUD, KIM (CFO)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04989-3230
Mailing Address - Country:US
Mailing Address - Phone:207-873-1756
Mailing Address - Fax:207-623-5779
Practice Address - Street 1:1 VA CTR
Practice Address - Street 2:PROSTHETIC SERVICE (126P)
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6719
Practice Address - Country:US
Practice Address - Phone:207-623-5769
Practice Address - Fax:207-623-5779
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CFO01953OtherABC CERFITICATION