Healthcare Provider Details

I. General information

NPI: 1134811599
Provider Name (Legal Business Name): MS. ASHLEY ELIZABETH JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SHUMAN AVE STE 16
AUGUSTA ME
04330-6020
US

IV. Provider business mailing address

842 MAIN ST
WAYNE ME
04284-3163
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-3900
  • Fax: 207-480-1541
Mailing address:
  • Phone: 706-761-2179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberTO4460
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: