Provider Demographics
NPI:1619859667
Name:STACK SPRAGUE, MICHELE LEE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:STACK SPRAGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KENMAR DR
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-4706
Mailing Address - Country:US
Mailing Address - Phone:617-692-0802
Mailing Address - Fax:
Practice Address - Street 1:25 LINNELL CIR
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-3928
Practice Address - Country:US
Practice Address - Phone:978-528-8596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist