MEDICARE: CHICKADEE OT ME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1184597551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICKADEE OT ME LLC

Provider Business Mailing Address
First Line	:	PO BOX 475
Second Line	:
City	:	GUILFORD
State	:	ME
Zip	:	04443-0475
Country	:	US
Telephone Number	:	207-604-8434
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 E MAIN ST
Second Line	:
City	:	DOVER FOXCROFT
State	:	ME
Zip	:	04426-1323
Country	:	US
Telephone Number	:	207-604-8434
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	BRYANNE LOVELL
Credential	:	OTR/L, CLC
Telephone Number	:	207-604-8434

Provider Enumeration Date	:	09/24/2025
Last Update Date	:	11/24/2025

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Directions to “CHICKADEE OT ME LLC ” Practice Location

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