Healthcare Provider Details

I. General information

NPI: 1144758111
Provider Name (Legal Business Name): MICHAEL ROBERT FOOTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 06/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GILL ST STE J
WOBURN MA
01801-1721
US

IV. Provider business mailing address

201 KING HILL RD
FRANCESTOWN NH
03043-3810
US

V. Phone/Fax

Practice location:
  • Phone: 617-505-6183
  • Fax: 617-505-6184
Mailing address:
  • Phone: 603-305-1369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: