Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | TA2193 | ME |
NPI | 1023273992 |
---|---|
Provider Name | Jane Bamford |
First Address | Bangor, ME 04401 |
Second Address | Bangor, ME 04401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2008 |
Last Update Date | 16/01/2015 |