Maxeen Wyatt, MT

NPI #1336308188 in South Portland, Maine

Provider Information

NPI Number: 1336308188
Entity Type: Individual
Name: Maxeen Wyatt, MT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Credential: MT
Enumeration Date: Jun 6, 2008
Last Updated: Jun 6, 2008

Practice Location

Address: 380 WESTERN AVE
City: South Portland
State: Maine
ZIP Code: 04106-1720
Phone: (207) 282-5110

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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