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General NPI Number Information
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NPI Number | 1033739545
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Entity Type | Organization
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Legal Business Name | JACOBS LADDER OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 526 HAMPDEN RD
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City | CARMEL
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State | ME
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Zip | 04419-3523
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Country | US
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Telephone | 207-991-7781
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Fax |
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Provider Business Mailing Address
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Address Line | 526 HAMPDEN RD
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City | CARMEL
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State | ME
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Zip | 04419-3523
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Country | US
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Telephone | 207-991-7781
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MS. SHERI L GRANT
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Credential | MOTR/L
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Telephone | 207-991-7781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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