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General NPI Number Information
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NPI Number | 1457784233
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Entity Type | Organization
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Legal Business Name | MAIN STREET THERAPY CENTER L.L.C.
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 141 MAIN ST
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City | ROCKLAND
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State | ME
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Zip | 04841-3808
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Country | US
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Telephone | 207-354-8963
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Fax |
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Provider Business Mailing Address
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Address Line | 141 MAIN ST
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City | ROCKLAND
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State | ME
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Zip | 04841-3808
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Country | US
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Telephone | 207-354-8963
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Fax |
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Authorized Official
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Title or Position | SPEECH - LANGUAGE PATHOLOGIST
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Name | PATRICIA TAYLOR
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Credential | MS. CCC-SLP
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Telephone | 207-594-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT2732
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP1281
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License Number State | ME
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