Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1508001751 |
---|---|
Provider Name | Ottie M Thomas-Smith |
First Address | Jackson, ME 04921-3314 |
Second Address | Boston, MA 02199-7820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2008 |
Last Update Date | 31/05/2011 |