Individual
MICHELLE ANN PROVENCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
38 BUGBEE RD, SOUTHWICK, MA 01077-9707
(413) 454-4146
Mailing address
38 BUGBEE RD, SOUTHWICK, MA 01077-9707
(413) 454-4146
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5067
MA
Other
Enumeration date
02/09/2020
Last updated
02/09/2020
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