Healthcare Provider Details

I. General information

NPI: 1598972705
Provider Name (Legal Business Name): JANE WOODRUFF OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 SOUTH MAIN STREET
SOLON ME
04979-0146
US

IV. Provider business mailing address

109 HARTLAND AVENUE
PITTSFIELD ME
04967-1432
US

V. Phone/Fax

Practice location:
  • Phone: 207-643-2491
  • Fax:
Mailing address:
  • Phone: 207-487-4762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT22
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: