Provider Demographics
NPI:1740866367
Name:MICHAUD, TABITHA ALAIN (MD)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:ALAIN
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:ALAIN MICHAUD
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 W OAK ST STE 201
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4998
Mailing Address - Country:US
Mailing Address - Phone:407-518-2703
Mailing Address - Fax:
Practice Address - Street 1:720 W OAK ST STE 201
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4998
Practice Address - Country:US
Practice Address - Phone:407-518-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program