Healthcare Provider Details

I. General information

NPI: 1891910212
Provider Name (Legal Business Name): ADAMS SPEECH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 KENNEDY MEMORIAL DR
WATERVILLE ME
04901-5132
US

IV. Provider business mailing address

PO BOX 257
WATERVILLE ME
04903-0257
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-5775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberSP1087
License Number StateME

VIII. Authorized Official

Name: TARA K ADAMS
Title or Position: PRESIDENT
Credential:
Phone: 207-872-5775