Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT1284 | ME |
NPI | 1508193830 |
---|---|
Provider Name | Kelly A Nesbitt |
First Address | Portland, ME 04101-2503 |
Second Address | Scarborough, ME 04074-9843 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2009 |
Last Update Date | 06/11/2009 |