Provider Demographics
NPI:1962713115
Name:SPRINGY POND FARM
Entity type:Organization
Organization Name:SPRINGY POND FARM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:CAMMACK
Authorized Official - Suffix:
Authorized Official - Credentials:OT/L
Authorized Official - Phone:207-537-3369
Mailing Address - Street 1:416 SPRINGY POND RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:ME
Mailing Address - Zip Code:04428-6175
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:562 SPRINGY POND RD.
Practice Address - Street 2:
Practice Address - City:OTIS
Practice Address - State:ME
Practice Address - Zip Code:04605
Practice Address - Country:US
Practice Address - Phone:207-356-2169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECO8403251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable