Individual
MICHELINE CHAMPAGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
999 N MAIN ST, RANDOLPH, MA 02368-3072
(781) 963-1697
(781) 963-5770
Mailing address
212 PAGE ST, AVON, MA 02322-1211
(508) 427-5512
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
13242
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y67978
BLUE CROSS BLUE SHIELD
MA
Enumeration date
05/26/2006
Last updated
07/01/2008
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