Healthcare Provider Details

I. General information

NPI: 1871874594
Provider Name (Legal Business Name): JENNIFER ST. PETER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CAMPUS DR
GUILFORD ME
04443-6315
US

IV. Provider business mailing address

9 CAMPUS DR
GUILFORD ME
04443-6315
US

V. Phone/Fax

Practice location:
  • Phone: 207-876-4635
  • Fax: 207-876-4363
Mailing address:
  • Phone: 207-876-4635
  • Fax: 207-876-4363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberTA2549
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: