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Individual

MISTY RAE STARBUCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MOTR-L

Contact information

Practice address
92 CUMBERLAND AVE APT 1, PORTLAND, ME 04101-2648
(207) 318-4681
(866) 220-5031
Mailing address
92 CUMBERLAND AVE APT 1, PORTLAND, ME 04101-2648
(207) 318-4681
(866) 220-5031

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT2400
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1225349830
ANTHEM OF MAINE
ME
Enumeration date
06/29/2010
Last updated
02/11/2011
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