Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT2613 | ME |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT2613 | ME |
NPI | 1861766453 |
---|---|
Provider Name | Miss Joyce P Kennedy |
First Address | Lewiston, ME 04240 |
Second Address | Lewiston, ME 04240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2012 |
Last Update Date | 14/04/2015 |