Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT670 | ME |
NPI | 1003229519 |
---|---|
Provider Name | Karie Davis |
First Address | Hermon, ME 04401-0665 |
Second Address | Hermon, ME 04401-0665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2014 |
Last Update Date | 03/06/2014 |