Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OA3023 | ME |
NPI | 1023686847 |
---|---|
Provider Name | Monica Lynn Whitman |
First Address | Augusta, ME 04330-6020 |
Second Address | Augusta, ME 04330-6020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2021 |
Last Update Date | 17/06/2021 |