Jefferson

Primary specialty

Local Education Agency (LEA)Taxonomy code 251300000X

Legal business name

JEFFERSON

Practice address

767 Main St # 1a
Damariscotta, ME 04543-4664

Phone

(207) 563-3044

Fax

(207) 563-8276

NPI assigned

Nov 17, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Deryl C. Holt

Title

Director of Special Services

Phone

(207) 563-3044

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• AOS 93 Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1258416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258416000000",
    "number": "1598092249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "767 MAIN ST # 1A",
            "city": "DAMARISCOTTA",
            "state": "ME",
            "postal_code": "045434664",
            "telephone_number": "207-563-3044",
            "fax_number": "207-563-8276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "767 MAIN ST # 1A",
            "city": "DAMARISCOTTA",
            "state": "ME",
            "postal_code": "045434664",
            "telephone_number": "207-563-3044",
            "fax_number": "207-563-8276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-17",
        "last_updated": "2009-11-17",
        "status": "A",
        "authorized_official_last_name": "HOLT",
        "authorized_official_first_name": "DERYL",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "DIRECTOR OF SPECIAL SERVICES",
        "authorized_official_telephone_number": "207-563-3044"
    },
    "taxonomies": [
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136720000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AOS 93",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Natalie Ann Hutchins, OTR/L
• Alissa Ide-Motta, L.AC.
• Insight-Premier Health LLC
• Intrinsic Health LLC
• Maryann Jacks, M.D.
• Eric Matthew Johnson, MD
• Jaime Jones
• Robert C. Kahn, M.D.
• Stephen Kahn, PH.D.
• Matthew Justin Kark, DO

• Local Education Agency (LEA) in Damariscotta, ME
• Providers in Damariscotta, ME by specialty
• Local Education Agency (LEA) in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.