Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1620 | ME |
NPI | 1770094534 |
---|---|
Provider Name | Ms. Kim Herrmann |
First Address | Falmouth, ME 04105-1768 |
Second Address | Falmouth, ME 04105-1768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2017 |
Last Update Date | 19/10/2017 |