Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT2780 | ME |
NPI | 1003938218 |
---|---|
Provider Name | Kristin C Johnston |
First Address | Augusta, ME 04330-7997 |
Second Address | Augusta, ME 04330-7997 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 03/05/2016 |