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General NPI Number Information
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NPI Number | 1558602862
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Entity Type | Individual
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Provider Name | EMILY MAE MUSHRALL MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/12/2013
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 103 TEXAS AVE
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City | BANGOR
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State | ME
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Zip | 04401-4324
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Country | US
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Telephone | 207-491-4727
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Fax |
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Provider Business Mailing Address
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Address Line | 510 WESTERN AVE
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City | HAMPDEN
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State | ME
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Zip | 04444-1028
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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 | OT2579
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License Number State | ME
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