Provider Demographics
NPI:1255147724
Name:BIGHAM, MICHELLE LEONE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEONE
Last Name:BIGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 AMERMAN DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535-7729
Mailing Address - Country:US
Mailing Address - Phone:541-890-8655
Mailing Address - Fax:
Practice Address - Street 1:805 AMERMAN DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:OR
Practice Address - Zip Code:97535-7729
Practice Address - Country:US
Practice Address - Phone:458-291-1603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner