Bonny Lee Saxon, BA, LMT
Individual provider Active NPI Specialist · Randolph, ME
NPI 1760637342 · NPPES record last updated Nov 24, 2008
Key facts
- NPI
- 1760637342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 417 (ME)
- Practice address
- 129 Water St
Randolph, ME 04346-5101 - Phone
- (207) 582-8158
- NPI assigned
- Nov 24, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 417 | ME | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 417 | ME | Yes |
Addresses
Primary practice location
129 Water St
Randolph, ME 04346-5101
Mailing address
129 Water St
Randolph, ME 04346-5101
Phone (207) 582-8158
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| VC0000105553 | Medicaid | ME |
Other providers in Randolph, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.