Provider Demographics
NPI:1255533170
Name:MICHAUD, JOELLA H (MS OTR L)
Entity type:Individual
Prefix:MRS
First Name:JOELLA
Middle Name:H
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:
Other - First Name:JOELLA
Other - Middle Name:
Other - Last Name:HEBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:333 BILLINGS ROAD
Mailing Address - Street 2:P.O. BOX 6360 HERMON TOWN OFFICE, SUPERINTENDENT'S
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-848-4000
Mailing Address - Fax:
Practice Address - Street 1:333 BILLINGS ROAD
Practice Address - Street 2:SUPERINTENDENT'S OFFICE.
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-848-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2031225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432481099Medicaid