Basic Information
| Provider Information | |||||||||
| NPI: | 1306254511 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUFRESNE | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Credential: | OT. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 MOHAWK LN | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038336427 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 522 AMHERST ST | ||||||||
| Address2: | STE 22 | ||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030631019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038800448 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2014 | ||||||||
| LastUpdateDate: | 07/31/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 2241 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.