Individual
SHANE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
587 OCEAN AVE, PORTLAND, ME 04103-2701
(207) 871-1211
Mailing address
899 RIVERSIDE ST, PORTLAND, ME 04103-1070
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
05/22/2014
Last updated
05/22/2014
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