Healthcare Provider Details

I. General information

NPI: 1306658331
Provider Name (Legal Business Name): MICHELLE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 MAIN ST
RICHMOND ME
04357-4016
US

IV. Provider business mailing address

504 MAIN ST
RICHMOND ME
04357-4016
US

V. Phone/Fax

Practice location:
  • Phone: 207-386-4029
  • Fax:
Mailing address:
  • Phone: 207-386-4029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT6046
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: