MEDICARE: MARY ANNE O. MOISAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT544	ME

General Provider Information

NPI Number	:	1013161108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANNE O. MOISAN

Provider Business Mailing Address
First Line	:	51 NOTCHED POND RD
Second Line	:
City	:	RAYMOND
State	:	ME
Zip	:	04071-6028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 FALCON DR
Second Line	:
City	:	AUBURN
State	:	ME
Zip	:	04210-4384
Country	:	US
Telephone Number	:	207-782-5437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2008
Last Update Date	:	06/11/2009

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