Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT656 | ME |
NPI | 1811136534 |
---|---|
Provider Name | Leslie Ann Tsomides |
First Address | Scarborough, ME 04074-8996 |
Second Address | Scarborough, ME 04074-8996 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2009 |
Last Update Date | 19/02/2009 |