Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT1935 | ME |
NPI | 1023259702 |
---|---|
Provider Name | Mrs. Gail Ann Lamoreau |
First Address | Lewiston, ME 04240-6421 |
Second Address | Lewiston, ME 04240-6421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2009 |
Last Update Date | 10/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
432150399 | (05) | ME |