Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT383 | ME |
NPI | 1003299199 |
---|---|
Provider Name | Cheryl Underhill-Tilton |
First Address | Augusta, ME 04330-8160 |
Second Address | Augusta, ME 04330-8160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2015 |
Last Update Date | 07/07/2015 |