Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | ATP14464 | ME |
NPI | 1255700670 |
---|---|
Provider Name | Thomas Gillis |
First Address | Berwick, ME 03901-2874 |
Second Address | Berwick, ME 03901-2874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2015 |
Last Update Date | 15/09/2015 |