Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT91 | ME |
NPI | 1003087016 |
---|---|
Provider Name | Martha Kolar Ives |
First Address | Portland, ME 04102-3315 |
Second Address | Portland, ME 04102-3315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2008 |
Last Update Date | 18/03/2008 |