Individual
MR. HENRY FULLER III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASTER OF SCIENCE OT
Contact information
Practice address
33 MILL ST, LISBON, ME 04250-6810
(207) 353-4132
(207) 353-4815
Mailing address
19 GARTLEY ST, LISBON, ME 04250-6431
(207) 353-6806
(207) 353-3038
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT246
ME
Other
Enumeration date
09/14/2010
Last updated
09/14/2010
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