Provider Demographics
NPI:1144758111
Name:FOOTE, MICHAEL ROBERT
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:FOOTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 KING HILL RD
Mailing Address - Street 2:
Mailing Address - City:FRANCESTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03043-3810
Mailing Address - Country:US
Mailing Address - Phone:603-305-1369
Mailing Address - Fax:
Practice Address - Street 1:10 GILL ST STE J
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1721
Practice Address - Country:US
Practice Address - Phone:617-505-6183
Practice Address - Fax:617-505-6184
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician