Healthcare Provider Details

I. General information

NPI: 1427947894
Provider Name (Legal Business Name): MICHELLE HAYLEY KELLEHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 TECHNOLOGY CTR DR STE 110
STOUGHTON MA
02072-4721
US

IV. Provider business mailing address

71 BRIERWOOD RD
BRAINTREE MA
02184-3807
US

V. Phone/Fax

Practice location:
  • Phone: 781-490-9522
  • Fax:
Mailing address:
  • Phone: 781-664-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: