Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT1426 | ME |
N | 225XH1200X | Occupational Therapist - Hand | OT1426 | ME |
NPI | 1104108463 |
---|---|
Provider Name | Kiley L Henderson |
First Address | Houlton, ME 04730-1603 |
Second Address | Houlton, ME 04730-1603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2011 |
Last Update Date | 16/05/2019 |