Basic Information
Provider Information
NPI: 1548781768
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REED
FirstName: MICHELE
MiddleName: MARIE
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 104 ELDERBERRY LN
Address2:  
City: ROUGEMONT
State: NC
PostalCode: 275729273
CountryCode: US
TelephoneNumber: 2032880033
FaxNumber:  
Practice Location
Address1: 1829 E FRANKLIN ST STE 600
Address2:  
City: CHAPEL HILL
State: NC
PostalCode: 275145863
CountryCode: US
TelephoneNumber: 9199683456
FaxNumber: 9199323456
Other Information
ProviderEnumerationDate: 06/28/2017
LastUpdateDate: 06/28/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X11015NCY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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