Individual
SUZANNE CICCOMANCINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
80 FALL BROOK ST, PORTLAND, ME 04103-4225
(207) 807-3763
Mailing address
80 FALL BROOK ST, PORTLAND, ME 04103-4225
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT562
ME
Other
Enumeration date
02/15/2016
Last updated
02/15/2016
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