Healthcare Provider Details

I. General information

NPI: 1093298614
Provider Name (Legal Business Name): NADIA HASHEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 CONGRESS ST
PORTLAND ME
04102-2715
US

IV. Provider business mailing address

959 CONGRESS ST
PORTLAND ME
04102-2715
US

V. Phone/Fax

Practice location:
  • Phone: 207-699-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3311
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: