Provider Demographics
NPI:1336787282
Name:JENKINS, CAROLANN MARIE (MS OT R/L)
Entity Type:Individual
Prefix:MISS
First Name:CAROLANN
Middle Name:MARIE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MS OT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GETCHELL ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2206
Mailing Address - Country:US
Mailing Address - Phone:207-598-0008
Mailing Address - Fax:
Practice Address - Street 1:58 DRUMMOND AVE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5755
Practice Address - Country:US
Practice Address - Phone:207-873-0695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3781225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist