Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 224Z00000X | ME |
NPI | 1013033232 |
---|---|
Provider Name | Miss Jessica May Lagasse |
First Address | Waterville, ME 04901-5070 |
Second Address | Waterville, ME 04901-5221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OA1693 | MAINE LICENCURE (01) | ME |