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Individual

MRS. BRENDA MITCHELL VAN DECKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
60 COURT STREET, AUBURN SCHOOL DEPARTMENT, AUBURN, ME 04212-0800
(207) 333-6600
Mailing address
167 LEACH HILL ROAD, CASCO, ME 04015
(207) 627-7207

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
O1613A
ME

Other

Enumeration date
09/01/2010
Last updated
09/01/2010
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