Healthcare Provider Details

I. General information

NPI: 1558277517
Provider Name (Legal Business Name): NAOMI KATHRYN JEAN BYLUND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SHUMAN AVE STE 16
AUGUSTA ME
04330-6020
US

IV. Provider business mailing address

36 BOLLING DR
BANGOR ME
04401-2805
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-3900
  • Fax: 207-480-1541
Mailing address:
  • Phone: 774-415-4176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberTO5070
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: