Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT1769 | ME |
NPI | 1366844920 |
---|---|
Provider Name | Carol Nightingale |
First Address | Lewiston, ME 04240-5935 |
Second Address | Lewiston, ME 04240-5935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2014 |
Last Update Date | 25/09/2014 |