=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841445632
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY FIGGINS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2008
-----------------------------------------------------
Last Update Date | 11/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1460 OUTER HAMMOND ST.
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-262-4200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 JILLIAN WAY
-----------------------------------------------------
City | GLENBURN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04401-1242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-262-4200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT713
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------