Individual
MRS. DONNA SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA/L
Contact information
Practice address
18 GROVE ST, NORWAY, ME 04268-5610
(207) 739-2242
(207) 739-2466
Mailing address
PO BOX 51, WEST PARIS, ME 04289-0051
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OA139
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
264470099
—
ME
Enumeration date
11/03/2008
Last updated
11/03/2008
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