Organization
ADVANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BERGERON OT (PRESIDENT)
(207) 786-0168
Entity
Organization
Contact information
Practice address
265 PINE ST, LEWISTON, ME 04240-6308
(207) 786-0168
Mailing address
265 PINE ST, LEWISTON, ME 04240-6308
(207) 786-0168
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202650000
—
ME
Enumeration date
12/13/2005
Last updated
06/16/2008
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