Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT1711 | ME |
NPI | 1811479116 |
---|---|
Provider Name | Patricia Dolan |
First Address | North Berwick, ME 03906-6724 |
Second Address | North Berwick, ME 03906-6724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2018 |
Last Update Date | 04/09/2018 |