Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1447267901 |
---|---|
Provider Name | Mrs. Priscille Belanger |
First Address | Biddeford, ME 04005-2590 |
Second Address | Biddeford, ME 04005-2590 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 07/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
129570000 | (05) | ME |
19Z018028ME01 | ANTHEM (01) | ME |