Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT1491 | ME |
NPI | 1407927411 |
---|---|
Provider Name | Donna L Anderson |
First Address | Portland, ME 04101-1823 |
Second Address | Portland, ME 04101-1823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002415 | ANTHEM BLUE SHIELD (01) | ME |