Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
Y | 225X00000X | Occupational Therapist | OT3480 | ME |
NPI | 1003396813 |
---|---|
Provider Name | Abbie Corbeau |
First Address | Windham, ME 04062-4473 |
Second Address | Portland, ME 04103-3629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2018 |
Last Update Date | 21/08/2018 |