Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | PT2805 | ME |
NPI | 1538720867 |
---|---|
Provider Name | Kelley Lee Crawford |
First Address | Albion, ME 04910-6513 |
Second Address | Portland, ME 04102-3175 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2019 |
Last Update Date | 26/06/2019 |