Healthcare Provider Details

I. General information

NPI: 1770045759
Provider Name (Legal Business Name): KATHERINE ANNE FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 MAIN RD
MILFORD ME
04461-3605
US

IV. Provider business mailing address

PO BOX 249
OLD TOWN ME
04468-0249
US

V. Phone/Fax

Practice location:
  • Phone: 207-356-8211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3604
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: