Individual
MRS. ELIZABETH BROADAWAY JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS OTR/L
Contact information
Practice address
125 PRESUMPSCOT ST, PORTLAND, ME 04103-5225
(207) 699-5531
(207) 699-5529
Mailing address
125 PRESUMPSCOT ST, PORTLAND, ME 04103-5225
(207) 699-5531
(207) 699-5529
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT2306
ME
Other
Enumeration date
06/24/2009
Last updated
06/24/2009
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