Healthcare Provider Details

I. General information

NPI: 1659787836
Provider Name (Legal Business Name): HANNAH M. PULLEN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SHUMAN AVE STE 16
AUGUSTA ME
04330
US

IV. Provider business mailing address

12 SHUMAN AVE STE 16
AUGUSTA ME
04330-6020
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-3900
  • Fax:
Mailing address:
  • Phone: 207-623-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberTA2893
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: