Provider Demographics
NPI:1245261841
Name:BARBER, MICHELLE L (ATC, CSCS)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:L
Last Name:BARBER
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:LEVREAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, CSCS
Mailing Address - Street 1:THREE KEANEY RD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881
Mailing Address - Country:US
Mailing Address - Phone:401-874-9065
Mailing Address - Fax:401-874-4804
Practice Address - Street 1:UNIVERSITY OF RHODE ISLAND
Practice Address - Street 2:THREE KEANEY ROAD, SUITE ONE
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881
Practice Address - Country:US
Practice Address - Phone:401-874-2051
Practice Address - Fax:401-874-4804
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT002032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer