Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OA2252 | ME |
NPI | 1013158401 |
---|---|
Provider Name | Mrs. Emily Stevens |
First Address | Sidney, ME 04330 |
Second Address | Sidney, ME 04330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2009 |
Last Update Date | 23/11/2009 |