Provider Demographics
NPI:1750088381
Name:AYOTTE, MICHAEL CHRISTOPHER
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:AYOTTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NY
Mailing Address - Zip Code:13667-0091
Mailing Address - Country:US
Mailing Address - Phone:315-514-4541
Mailing Address - Fax:
Practice Address - Street 1:84 PARK ST
Practice Address - Street 2:
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-1719
Practice Address - Country:US
Practice Address - Phone:315-514-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist