Provider Demographics
NPI:1568796597
Name:ADAMS, JENNIFER LYNN (PTA, LMT)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYNN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04098-0310
Mailing Address - Country:US
Mailing Address - Phone:207-854-1239
Mailing Address - Fax:207-854-1230
Practice Address - Street 1:1 WESTBROOK CMN
Practice Address - Street 2:SUITE 2
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2804
Practice Address - Country:US
Practice Address - Phone:207-854-1239
Practice Address - Fax:207-854-1230
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1667174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2497900099Medicaid