Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 2621 | ME |
NPI | 1174948913 |
---|---|
Provider Name | Erin Masterson |
First Address | South Portland, ME 04106-6615 |
Second Address | South Portland, ME 04106-6615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2014 |
Last Update Date | 04/03/2014 |