Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT3296 | ME |
N | 225XG0600X | Occupational Therapist - Gerontology | OT3296 | ME |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT3296 | ME |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT3296 | ME |
NPI | 1881120897 |
---|---|
Provider Name | Michelle Dubois |
First Address | Sanford, ME 04073-5143 |
Second Address | Sanford, ME 04073-5143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 11/05/2017 |