Healthcare Provider Details

I. General information

NPI: 1144488339
Provider Name (Legal Business Name): ROBERT CRAIG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2008
Last Update Date: 05/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 PORTLAND ST
YARMOUTH ME
04096-8101
US

IV. Provider business mailing address

27 LAFAYETTE ST APT. 2
YARMOUTH ME
04096-6781
US

V. Phone/Fax

Practice location:
  • Phone: 207-846-9021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number#OA1422
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: