Provider Demographics
NPI:1295119139
Name:MATHIEU, MICHELLE NICOLE (TOTA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NICOLE
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:TOTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 CONY RD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:CHELSEA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-1054
Mailing Address - Country:US
Mailing Address - Phone:207-582-8400
Mailing Address - Fax:207-582-8401
Practice Address - Street 1:434 CONY RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CHELSEA
Practice Address - State:ME
Practice Address - Zip Code:04330-1054
Practice Address - Country:US
Practice Address - Phone:207-582-8400
Practice Address - Fax:207-582-8401
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
META3041224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant