Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | MA |
NPI | 1669937181 |
---|---|
Provider Name | Janet M Soderquist |
First Address | Manchester, NH 03109-5207 |
Second Address | Manchester, NH 03109-5207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2019 |
Last Update Date | 08/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110066943A | (05) | MA |
3079514 | (05) | NH |
METPID002735 | (05) | ME |