Individual
ALYSSA CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
118 MAINE MALL RD, SOUTH PORTLAND, ME 04106-2309
(207) 772-1031
Mailing address
58 ACADEMY ST, AUBURN, ME 04210-5705
(207) 461-5824
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MT6607
ME
Other
Enumeration date
09/09/2024
Last updated
09/09/2024
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