Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 003862 | CT |
N | 225X00000X | Occupational Therapist | 10511 | MA |
N | 225X00000X | Occupational Therapist | 2201 | NH |
Y | 225X00000X | Occupational Therapist | OT2570 | ME |
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1043554405 |
---|---|
Provider Name | Jennifer Helen Gustafson |
First Address | York, ME 03909-5455 |
Second Address | York, ME 03909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2012 |
Last Update Date | 04/06/2018 |