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Individual
MS. MICHELE ELIZABETH DEROUEN
Active
Individual
MS. MICHELE ELIZABETH DEROUEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSPTA
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NM
225200000X
Physical Therapy Assistant
A-0719
NM
Other
Enumeration date
11/16/2012
Last updated
04/14/2022
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