Individual
JEFF THIBEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
66 BRIDGE ST, BUCKSPORT, ME 04416-4087
(207) 469-6642
Mailing address
66 BRIDGE ST, BUCKSPORT, ME 04416-4087
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OA388
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OA388
—
ME
Enumeration date
01/22/2015
Last updated
01/22/2015
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