Healthcare Provider Details

I. General information

NPI: 1699793794
Provider Name (Legal Business Name): MARGARET ANNE SMITH OTR LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 UNION ST
BANGOR ME
04401-0000
US

IV. Provider business mailing address

1048 UNION ST SUITE 5
BANGOR ME
04401-0000
US

V. Phone/Fax

Practice location:
  • Phone: 207-945-5247
  • Fax: 207-947-0435
Mailing address:
  • Phone: 207-945-5247
  • Fax: 207-947-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT2661
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT307
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: