Healthcare Provider Details

I. General information

NPI: 1861893869
Provider Name (Legal Business Name): MS. BETH MORSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ROGERS RD
VASSALBORO ME
04989-4000
US

IV. Provider business mailing address

P.O. BOX 275
NORTH VASSALBORO ME
04962
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-3688
  • Fax:
Mailing address:
  • Phone: 207-873-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCO19896
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: