Provider Demographics
NPI:1700418845
Name:KING, PATRICIA AVERILL (CTRS CBIS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:AVERILL
Last Name:KING
Suffix:
Gender:F
Credentials:CTRS CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 SKOWHEGAN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-3479
Mailing Address - Country:US
Mailing Address - Phone:207-453-1330
Mailing Address - Fax:
Practice Address - Street 1:95 SKOWHEGAN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-3479
Practice Address - Country:US
Practice Address - Phone:207-453-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist