Provider Demographics
NPI:1912444134
Name:DRUMMOND, MICHELE OLIVIA (MT, MP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:OLIVIA
Last Name:DRUMMOND
Suffix:
Gender:F
Credentials:MT, MP
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 22940
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99802-2940
Mailing Address - Country:US
Mailing Address - Phone:907-321-3484
Mailing Address - Fax:907-586-1885
Practice Address - Street 1:119 SEWARD ST STE 19
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1268
Practice Address - Country:US
Practice Address - Phone:907-321-3484
Practice Address - Fax:907-586-1885
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK109335225700000X
WAMA 60196168225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist