=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093173171
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE DIGIROLAMO LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2016
-----------------------------------------------------
Last Update Date | 02/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 91 ELM ST
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04843-1906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-236-3338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 86 SCHOOL ST
-----------------------------------------------------
City | DAMARISCOTTA
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04543-4625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-236-3338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT821
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------