Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT1582 | ME |
NPI | 1003005968 |
---|---|
Provider Name | Mr. John Joseph Majkut |
First Address | Portland, ME 04102-2909 |
Second Address | Portland, ME 04102-2909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2007 |
Last Update Date | 17/10/2007 |