Basic Information
| Provider Information | |||||||||
| NPI: | 1447452362 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONOVAN | ||||||||
| FirstName: | CLAIRE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 246 7TH ST | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044015847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079475260 | ||||||||
| FaxNumber: | 2079475260 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 MT HOPE AVE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044015680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079412952 | ||||||||
| FaxNumber: | 2079412955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 01/14/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT2990 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.