Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT2381 | ME |
NPI | 1073010377 |
---|---|
Provider Name | Lacey Beth Cormier |
First Address | Mercer, ME 04957-4851 |
Second Address | Farmington, ME 04938-6241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2018 |
Last Update Date | 12/04/2018 |