Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OT3102 | ME |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT3102 | ME |
NPI | 1750745485 |
---|---|
Provider Name | Mrs. Monica Bradford |
First Address | Bangor, ME 04401-3009 |
Second Address | Bangor, ME 04401-3009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2016 |
Last Update Date | 08/04/2016 |