Healthcare Provider Details

I. General information

NPI: 1235398553
Provider Name (Legal Business Name): NANCY JANE BEADLING CFOM, CMT, CLT,COTA/
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247A LAKEVIEW DR
SOUTH CHINA ME
04358-5616
US

IV. Provider business mailing address

247A LAKEVIEW DR
SOUTH CHINA ME
04358-5616
US

V. Phone/Fax

Practice location:
  • Phone: 207-624-2997
  • Fax:
Mailing address:
  • Phone: 207-624-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number37578
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOA2580
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT714
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: