Healthcare Provider Details

I. General information

NPI: 1124648555
Provider Name (Legal Business Name): SALENA SYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 08/31/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MAURICE DR
BRUNSWICK ME
04011-3270
US

IV. Provider business mailing address

29 MAURICE DR
BRUNSWICK ME
04011-3270
US

V. Phone/Fax

Practice location:
  • Phone: 207-725-7495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: