Provider Demographics
NPI:1407678139
Name:MARTINEAU, MICHELLE (NBC-HWC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MARTINEAU
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 CHESHIRE ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1807
Mailing Address - Country:US
Mailing Address - Phone:203-257-6839
Mailing Address - Fax:
Practice Address - Street 1:1276 CHESHIRE ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1807
Practice Address - Country:US
Practice Address - Phone:203-257-6839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTA-3814469171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach