MEDICARE: TOWN OF WILLIMANTIC

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1831426006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN OF WILLIMANTIC

Provider Business Mailing Address
First Line	:	144 PRITHAM AVENUE
Second Line	:
City	:	GREENVILLE
State	:	ME
Zip	:	04441-0000
Country	:	US
Telephone Number	:	207-695-3708
Fax Number	:	207-695-3709

Provider Business Practice Location Address
First Line	:	144 PRITHAM AVENUE
Second Line	:
City	:	GREENVILLE
State	:	ME
Zip	:	04441-0000
Country	:	US
Telephone Number	:	207-695-3708
Fax Number	:	207-695-3709

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MRS. HEATHER JANE PERRY
Credential	:	ME.D
Telephone Number	:	207-695-3708

Provider Enumeration Date	:	11/10/2009
Last Update Date	:	11/10/2009

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Directions to “TOWN OF WILLIMANTIC ” Practice Location

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