Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT3933 | ME |
NPI | 1912492182 |
---|---|
Provider Name | Hailey Rae Smith |
First Address | Dexter, ME 04930-1470 |
Second Address | Dexter, ME 04930-1470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2018 |
Last Update Date | 28/06/2018 |