Provider Demographics
NPI:1023273992
Name:BAMFORD, JANE (COTA)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BAMFORD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GILMAN PLAZA
Mailing Address - Street 2:C/O WATCH ME SHINE, INC.
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-990-0162
Mailing Address - Fax:207-990-0163
Practice Address - Street 1:28 GILMAN PLAZA
Practice Address - Street 2:C/O WATCH ME SHINE, INC.
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-990-0162
Practice Address - Fax:207-990-0163
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
META2193224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant