Individual
JESSICA BERGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
51 WINSHIP ST, BATH, ME 04530
(207) 443-9772
Mailing address
589 POLAND RANGE RD, POWNAL, ME 04069
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT2045
ME
Other
Enumeration date
09/15/2015
Last updated
09/15/2015
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