Provider Demographics
NPI:1104600055
Name:COLLINS, MICHELLE KATHLEEN
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KATHLEEN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CUMMINGS CTR # 266V
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6175
Mailing Address - Country:US
Mailing Address - Phone:978-728-7085
Mailing Address - Fax:
Practice Address - Street 1:800 CUMMINGS CTR # 266V
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6175
Practice Address - Country:US
Practice Address - Phone:978-728-7085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist