Provider Demographics
NPI:1790998839
Name:DELOSSANTOS, MICHELLE LOUISE (MSATC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LOUISE
Last Name:DELOSSANTOS
Suffix:
Gender:F
Credentials:MSATC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:130 CAMELOT DR
Mailing Address - Street 2:APT. A10
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-6457
Mailing Address - Country:US
Mailing Address - Phone:989-245-6056
Mailing Address - Fax:
Practice Address - Street 1:3901 BAY RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2438
Practice Address - Country:US
Practice Address - Phone:989-797-6040
Practice Address - Fax:989-797-6054
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer