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General NPI Number Information
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NPI Number | 1811124662
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Entity Type | Organization
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Legal Business Name | WATCH ME SHINE, INC.
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 02/13/2015
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Provider Practice Location Address
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Address Line | 28 GILMAN PLAZA
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City | BANGOR
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State | ME
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Zip | 04401
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Country | US
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Telephone | 207-990-0162
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Fax | 207-990-0163
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Provider Business Mailing Address
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Address Line | 122 JILLIAN WAY C/O TIFFANY PETRONIS
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City | GLENBURN
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State | ME
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Zip | 04401
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Country | US
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Telephone | 207-990-0162
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Fax | 207-990-0163
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. TIFFANY S. PETRONIS
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Credential |
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Telephone | 207-664-8132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 609327
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License Number State | ME
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