Provider Demographics
NPI:1578225025
Name:BARTLETT, JESSY MEAGAN (PTA)
Entity Type:Individual
Prefix:
First Name:JESSY
Middle Name:MEAGAN
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JESSY
Other - Middle Name:MEAGAN
Other - Last Name:DEVOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:82 SYLVAN RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4221
Mailing Address - Country:US
Mailing Address - Phone:207-401-4324
Mailing Address - Fax:207-401-4325
Practice Address - Street 1:82 SYLVAN RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4221
Practice Address - Country:US
Practice Address - Phone:207-401-4324
Practice Address - Fax:207-401-4325
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA5710225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant