Provider Demographics
NPI:1023740222
Name:BLAKE, MICHELLE (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:POISSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:16 ALICE DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-2111
Mailing Address - Country:US
Mailing Address - Phone:508-965-9534
Mailing Address - Fax:
Practice Address - Street 1:55 HARRIS RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-2145
Practice Address - Country:US
Practice Address - Phone:603-888-1573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2293225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation