Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT1396 | ME |
NPI | 1053626614 |
---|---|
Provider Name | Denise Paquette |
First Address | Lewiston, ME 04240-1644 |
Second Address | Auburn, ME 04210-4387 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2010 |
Last Update Date | 06/08/2010 |