Individual
MARY ELIZABETH WAGSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
SEAPORT VILLAGE HEALTHCARE, 19 GENERAL MOORE WAY, ELLSWORTH, ME 04605
(207) 667-9336
Mailing address
35 UPLAND WAY, ELLSWORTH, ME 04605-3475
(207) 266-4396
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
OT955
ME
Other
Enumeration date
03/12/2019
Last updated
04/16/2020
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