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General NPI Number Information
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NPI Number | 1164747838
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Entity Type | Individual
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Provider Name | TASHA GRADIE MSOTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/06/2010
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Last Update Date | 02/07/2020
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Provider Practice Location Address
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Address Line | 52 HORSE POINT RD
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City | BELGRADE
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State | ME
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Zip | 04917-3013
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Country | US
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Telephone | 207-649-8470
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Fax |
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Provider Business Mailing Address
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Address Line | 52 HORSE POINT RD
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City | BELGRADE
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State | ME
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Zip | 04917-3013
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OT1423
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License Number State | ME
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