Healthcare Provider Details

I. General information

NPI: 1831330570
Provider Name (Legal Business Name): MARTHA PARO LANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 S HIRAM RD
HIRAM ME
04041-3636
US

IV. Provider business mailing address

137 S HIRAM RD
HIRAM ME
04041-3636
US

V. Phone/Fax

Practice location:
  • Phone: 207-934-0458
  • Fax: 207-872-6116
Mailing address:
  • Phone: 207-934-0458
  • Fax: 207-872-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSAS1690
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: