Provider Demographics
NPI:1811186158
Name:SUPAN-MATHIEU, JULEE CAY
Entity Type:Individual
Prefix:
First Name:JULEE
Middle Name:CAY
Last Name:SUPAN-MATHIEU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BRUNELLE AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-5530
Mailing Address - Country:US
Mailing Address - Phone:207-490-6951
Mailing Address - Fax:
Practice Address - Street 1:29 BRUNELLE AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-5530
Practice Address - Country:US
Practice Address - Phone:207-490-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT3297225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist