Individual
MRS. DIANE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15 BEECH ST, FARMINGDALE, ME 04344-1603
(207) 622-2976
Mailing address
15 BEECH ST, FARMINGDALE, ME 04344-1603
(207) 622-2976
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
403825
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135210000
—
ME
Enumeration date
01/07/2010
Last updated
01/07/2010
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