Provider Demographics
NPI:1881997880
Name:MICHAUD, VIVIAN (LDT)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:LDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1747
Mailing Address - Country:US
Mailing Address - Phone:800-884-6973
Mailing Address - Fax:
Practice Address - Street 1:11288 SAINT PETERS RD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-9125
Practice Address - Country:US
Practice Address - Phone:812-623-2106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist