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NPI Code Detail

MEDICARE: ALICEN MARY JOHNSON OT

MEDICARE: ALICEN MARY JOHNSON OT
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
1225X00000XOccupational TherapistOT3048ME

General Provider Information

NPI Number : 1487010492
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICEN MARY JOHNSON OT
Provider Business Mailing Address
First Line : 78 ATLANTIC PL
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-2316
Country : US
Telephone Number : 207-661-6654
Fax Number : 207-842-7773
Provider Business Practice Location Address
First Line : 236 GANNETT DR
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-6913
Country : US
Telephone Number : 207-661-3600
Fax Number : 207-761-0783
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2016
Last Update Date : 01/06/2016

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Directions to “ ALICEN MARY JOHNSON OT” Practice Location

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