=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841188752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOJO ROBERTELIJAH PICONE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2025
-----------------------------------------------------
Last Update Date | 06/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 WESTBROOK CMN
-----------------------------------------------------
City | WESTBROOK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04092-2819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-591-7210
-----------------------------------------------------
Fax | 207-591-7213
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 NEW YORK AVE
-----------------------------------------------------
City | SOUTH PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04106-6023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-951-2236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------