Healthcare Provider Details

I. General information

NPI: 1275824914
Provider Name (Legal Business Name): CANDICE MARIE VRONA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SPRING ST STE A
SCARBOROUGH ME
04074-8926
US

IV. Provider business mailing address

190 RIVERSIDE ST UNIT 6B
PORTLAND ME
04103-1073
US

V. Phone/Fax

Practice location:
  • Phone: 207-396-7337
  • Fax: 207-885-4349
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10015
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number01230
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3294
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: