Individual
NICOLE B. KENISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
152 US-1, SCARBOROUGH, ME 04074
(207) 883-5882
Mailing address
20 GOSHEN RD, WINDHAM, ME 04062-6309
(078) 076-2262
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT3968
ME
225XP0200X
Pediatric Occupational Therapist
Primary
OT3968
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OT3968
—
ME
Enumeration date
07/21/2021
Last updated
01/29/2024
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