Healthcare Provider Details

I. General information

NPI: 1093847097
Provider Name (Legal Business Name): KIDS IN ACTION P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HASSON ST
FARMINGDALE ME
04344-1613
US

IV. Provider business mailing address

15 HASSON ST
FARMINGDALE ME
04344-1613
US

V. Phone/Fax

Practice location:
  • Phone: 207-582-8400
  • Fax: 207-582-8401
Mailing address:
  • Phone: 207-582-8400
  • Fax: 207-582-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. LISA M MAZZOLA
Title or Position: PRESIDENT
Credential: OTRL
Phone: 207-582-8400