Healthcare Provider Details

I. General information

NPI: 1902186265
Provider Name (Legal Business Name): MEGAN BISSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HAMEL RDG
RICHMOND ME
04357-3441
US

IV. Provider business mailing address

17 HAMEL RDG
RICHMOND ME
04357-3441
US

V. Phone/Fax

Practice location:
  • Phone: 207-837-8320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2249
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: