=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942455944
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANE K KITCHEN PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2008
-----------------------------------------------------
Last Update Date | 11/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1068 MAIN ST
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04073-3606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-324-6789
-----------------------------------------------------
Fax | 207-324-9394
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 451 FORD QUINT RD
-----------------------------------------------------
City | NORTH BERWICK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 03906-5954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-459-7170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT2452
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------