Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | TO2573 | ME |
NPI | 1003192188 |
---|---|
Provider Name | Miss Casey L Nightingale |
First Address | Presque Isle, ME 04769-2877 |
Second Address | Presque Isle, ME 04769-2474 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2011 |
Last Update Date | 02/11/2011 |