Provider Demographics
NPI:1972853588
Name:OAKES, BYRON JUDSON (LLI,MHRT-1, PSS)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:JUDSON
Last Name:OAKES
Suffix:
Gender:M
Credentials:LLI,MHRT-1, PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468-1411
Mailing Address - Country:US
Mailing Address - Phone:207-299-8279
Mailing Address - Fax:
Practice Address - Street 1:220 4TH ST
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-1411
Practice Address - Country:US
Practice Address - Phone:207-299-8279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELIT318171R00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171R00000XOther Service ProvidersInterpreter