Healthcare Provider Details

I. General information

NPI: 1659688901
Provider Name (Legal Business Name): JESSICA L MOSHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E CHESTNUT ST UNIT 100
AUGUSTA ME
04330-5765
US

IV. Provider business mailing address

108 COOKSON LN
WHITEFIELD ME
04353-3139
US

V. Phone/Fax

Practice location:
  • Phone: 207-582-8400
  • Fax: 207-582-8401
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT1257
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: