Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT417 | ME |
NPI | 1003282716 |
---|---|
Provider Name | Valerie Pranckunas |
First Address | Augusta, ME 04330-8160 |
Second Address | Augusta, ME 04330-8160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2015 |
Last Update Date | 17/08/2015 |