MEDICARE: MRS. ASHLEY ANNE JUAT MOT, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	10375	MA
2	225XP0200X	Pediatric Occupational Therapist	4763	AZ
3	225XP0200X	Pediatric Occupational Therapist	2879	ME

General Provider Information

NPI Number	:	1669771119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY ANNE JUAT MOT, OTR/L

Provider Business Mailing Address
First Line	:	24 STONE ST STE 101
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-5209
Country	:	US
Telephone Number	:	207-582-8400
Fax Number	:	207-230-6701

Provider Business Practice Location Address
First Line	:	24 STONE ST STE 101
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-5209
Country	:	US
Telephone Number	:	207-582-8400
Fax Number	:	207-230-6701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	11/23/2021

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