Individual
ELIZABETH BROUSSEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
404 GRAY RD, WINDHAM, ME 04062-4290
(207) 892-1840
Mailing address
404 GRAY RD, WINDHAM, ME 04062-4290
(207) 892-1840
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OA979
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OA979
STATE OF MAINE BOARD OF OCCUPATIONAL THERAPY PRACTICE
ME
Enumeration date
09/16/2010
Last updated
09/16/2010
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