Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT3431 | ME |
NPI | 1235697814 |
---|---|
Provider Name | Thomas Edward Jones II |
First Address | Millinocket, ME 04462-2125 |
Second Address | Millinocket, ME 04462-2125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2019 |
Last Update Date | 04/03/2019 |