Individual
MICHELLE LEA RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1318 US ROUTE 202, SUITE D, WINTHROP, ME 04364-3821
(207) 377-5902
(207) 377-5904
Mailing address
233 HARLOW HILL RD, TURNER, ME 04282-3521
(207) 225-2857
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT665
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015505
ANTHEM
ME
Enumeration date
09/08/2006
Last updated
07/09/2007
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