Provider Demographics
NPI:1972878643
Name:FITZPATRICK, MICHELLE CHRISTINE (FINISH OPTICLAL TECH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:FINISH OPTICLAL TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:BORING
Mailing Address - State:OR
Mailing Address - Zip Code:97009-0352
Mailing Address - Country:US
Mailing Address - Phone:503-954-5588
Mailing Address - Fax:
Practice Address - Street 1:34175 SE BROOKS RD
Practice Address - Street 2:
Practice Address - City:BORING
Practice Address - State:OR
Practice Address - Zip Code:97009-8710
Practice Address - Country:US
Practice Address - Phone:503-954-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other