Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT52 | ME |
NPI | 1053680652 |
---|---|
Provider Name | Judith Yeaton |
First Address | Rockland, ME 04841-2455 |
Second Address | Rockland, ME 04841-2455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2011 |
Last Update Date | 28/12/2011 |