Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 939 | ME |
NPI | 1003142134 |
---|---|
Provider Name | Jacalyn Dawn Bubier |
First Address | Biddeford, ME 04005-2923 |
Second Address | Biddeford, ME 04005-2923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2009 |
Last Update Date | 24/10/2009 |