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General NPI Number Information
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NPI Number | 1407076441
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Entity Type | Individual
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Provider Name | MICHELLE OUELLETTE
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 27240 HAGGERTY RD E-15
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-5716
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Country | US
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Telephone | 866-991-0900
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Fax | 866-992-0900
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Provider Business Mailing Address
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Address Line | 1616 RIDGE RD
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City | LEWISTON
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State | NY
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Zip | 14092-9752
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Country | US
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Telephone | 617-447-1272
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 30386
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 70014579
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 21765
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License Number State | MD
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