Provider Demographics
NPI:1093972770
Name:POTVIN, JAYNE L (LMT)
Entity Type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:L
Last Name:POTVIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-2004
Mailing Address - Country:US
Mailing Address - Phone:207-210-0007
Mailing Address - Fax:
Practice Address - Street 1:51 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-2004
Practice Address - Country:US
Practice Address - Phone:207-210-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT2179225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist