Healthcare Provider Details

I. General information

NPI: 1245661495
Provider Name (Legal Business Name): MICHELE RIVARD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 MAIN ST
SPRINGVALE ME
04083-1511
US

IV. Provider business mailing address

554 MAIN ST
SPRINGVALE ME
04083-1511
US

V. Phone/Fax

Practice location:
  • Phone: 207-324-5372
  • Fax:
Mailing address:
  • Phone: 207-324-5372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberMT 814
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: