Provider Demographics
NPI:1396938957
Name:CLEPHANE, MICHELE ELANE (LMBT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ELANE
Last Name:CLEPHANE
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CAHLFIELD CT
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1698
Mailing Address - Country:US
Mailing Address - Phone:919-389-5103
Mailing Address - Fax:
Practice Address - Street 1:900 CAHLFIELD CT
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1698
Practice Address - Country:US
Practice Address - Phone:919-389-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3354225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist