Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT1583 | ME |
NPI | 1104125012 |
---|---|
Provider Name | Erin Shaw-Nkurunziza |
First Address | Cape Elizabeth, ME 04107-2628 |
Second Address | Cape Elizabeth, ME 04107-2620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2011 |
Last Update Date | 02/01/2013 |