Basic Information
| Provider Information | |||||||||
| NPI: | 1003142134 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUBIER | ||||||||
| FirstName: | JACALYN | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 MAY ST | ||||||||
| Address2: | |||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040052923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072824138 | ||||||||
| FaxNumber: | 2072828242 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 MAY ST | ||||||||
| Address2: | |||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040052923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072824138 | ||||||||
| FaxNumber: | 2072828242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2009 | ||||||||
| LastUpdateDate: | 10/24/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 939 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.