Healthcare Provider Details

I. General information

NPI: 1275495459
Provider Name (Legal Business Name): JAIME TIBBETTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 HANOVER ST
SKOWHEGAN ME
04976-1304
US

IV. Provider business mailing address

14 HANOVER ST
SKOWHEGAN ME
04976-1304
US

V. Phone/Fax

Practice location:
  • Phone: 207-399-0496
  • Fax:
Mailing address:
  • Phone: 207-399-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOA1281
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: