Provider Demographics
NPI:1306986708
Name:MCDONALD, MICHELLE A (LMP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:A
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:SCHUNZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1601 2ND AVE N STE 217
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3243
Mailing Address - Country:US
Mailing Address - Phone:253-350-1928
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND AVE N STE 217
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3243
Practice Address - Country:US
Practice Address - Phone:253-630-6768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003344174400000X
MT11914225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-1822530OtherTAX ID