Provider Demographics
NPI:1194450973
Name:MACDONALD, MICHAELA L (CMT)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:L
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 LEONARD HILL RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:VT
Mailing Address - Zip Code:05824-9530
Mailing Address - Country:US
Mailing Address - Phone:802-535-8889
Mailing Address - Fax:
Practice Address - Street 1:134 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-5602
Practice Address - Country:US
Practice Address - Phone:802-535-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT164.0000671225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist