Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT3484 | ME |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT3484 | ME |
NPI | 1063987774 |
---|---|
Provider Name | Leah Hanks |
First Address | Turner, ME 04282-4616 |
Second Address | Norway, ME 04268-5653 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2018 |
Last Update Date | 09/10/2018 |