Healthcare Provider Details

I. General information

NPI: 1255487211
Provider Name (Legal Business Name): MRS. VIVIAN IRENE THERRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MERCHANT LN
ADDISON ME
04606-3363
US

IV. Provider business mailing address

20 MERCHANT LN
ADDISON ME
04606-3363
US

V. Phone/Fax

Practice location:
  • Phone: 207-497-5633
  • Fax: 207-497-5633
Mailing address:
  • Phone: 207-497-5633
  • Fax: 207-497-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier198850000
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: