Basic Information
| Provider Information | |||||||||
| NPI: | 1508221599 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEARSON | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | DAWN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OT | ||||||||
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| OtherLastName: | GIBB | ||||||||
| OtherFirstName: | MICHELE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 54 RIVER GROVE | ||||||||
| Address2: | BOX 395 | ||||||||
| City: | SANFORD | ||||||||
| State: | MANITOBA | ||||||||
| PostalCode: | R0G 2J0 | ||||||||
| CountryCode: | CA | ||||||||
| TelephoneNumber: | 2044790959 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5419 N LOVINGTON HWY | ||||||||
| Address2: | |||||||||
| City: | HOBBS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882409100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5754925000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2015 | ||||||||
| LastUpdateDate: | 12/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 3459 | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.