Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT74 | ME |
NPI | 1124542428 |
---|---|
Provider Name | Alice L Vanderwerken |
First Address | Farmington, ME 04938-6937 |
Second Address | Farmington, ME 04938-6937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2017 |
Last Update Date | 08/08/2017 |