Individual
SUSAN FICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
133 CORPORATE DR, SUITE 2, BANGOR, ME 04401-4312
(207) 992-9286
(207) 992-9287
Mailing address
PO BOX 921, BANGOR, ME 04402-0921
(207) 942-7650
(207) 990-5586
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT504
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
249170099
—
ME
01
—
2944638
AETNA
ME
Enumeration date
08/05/2006
Last updated
01/21/2009
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