Healthcare Provider Details

I. General information

NPI: 1184926503
Provider Name (Legal Business Name): JULIE ANN WATERMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 ALLEN AVE
PORTLAND ME
04103-3711
US

IV. Provider business mailing address

127 HARDY RD
FALMOUTH ME
04105-2483
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-8100
  • Fax:
Mailing address:
  • Phone: 207-450-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberOT280
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: