MEDICARE: MS. BRECCA LYNN MICHAUD OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT13671	FL
2	225X00000X	Occupational Therapist	OT0633	AR

General Provider Information

NPI Number	:	1710099023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRECCA LYNN MICHAUD OTR/L

Provider Business Mailing Address
First Line	:	1951 BAYOU GRANDE BLVD NE
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33703-1911
Country	:	US
Telephone Number	:	727-300-9471
Fax Number	:

Provider Business Practice Location Address
First Line	:	1951 BAYOU GRANDE BLVD NE
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33703-1911
Country	:	US
Telephone Number	:	727-300-9471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/23/2020

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