Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT1308 | ME |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT1308 | ME |
NPI | 1033325238 |
---|---|
Provider Name | Ms. Diane Palmer Bergey |
First Address | Belfast, ME 04915-6142 |
Second Address | Belfast, ME 04915-6571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 01/07/2013 |