Provider Demographics
NPI:1265554653
Name:WOODBREY HAND & PEDIATRIC THERAPY, INC.
Entity type:Organization
Organization Name:WOODBREY HAND & PEDIATRIC THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOODBREY JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:207-262-7173
Mailing Address - Street 1:PO BOX 835
Mailing Address - Street 2:281 BURLEIGH RD
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0835
Mailing Address - Country:US
Mailing Address - Phone:207-262-7173
Mailing Address - Fax:207-947-2465
Practice Address - Street 1:281 BURLEIGH RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2511
Practice Address - Country:US
Practice Address - Phone:207-262-7173
Practice Address - Fax:207-947-2465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT219261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME202200000Medicaid
ME202200000Medicaid