Provider Demographics
NPI:1851695589
Name:DEVEAU, MICHELLE RUTH (BA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RUTH
Last Name:DEVEAU
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:RUTH
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10J GILL ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1721
Mailing Address - Country:US
Mailing Address - Phone:781-932-8888
Mailing Address - Fax:
Practice Address - Street 1:10J GILL ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1721
Practice Address - Country:US
Practice Address - Phone:781-932-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist