Healthcare Provider Details

I. General information

NPI: 1033444815
Provider Name (Legal Business Name): MICHELLE DAWN HARDY LMT, ICCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3523 W RAWSON AVE
FRANKLIN WI
53132-8367
US

IV. Provider business mailing address

3523 W RAWSON AVE
FRANKLIN WI
53132-8367
US

V. Phone/Fax

Practice location:
  • Phone: 414-446-7107
  • Fax:
Mailing address:
  • Phone: 414-446-7107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3819-146
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: