Healthcare Provider Details

I. General information

NPI: 1699269449
Provider Name (Legal Business Name): JESSIE MAE ROH CHABOT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 PORTLAND RD
ARUNDEL ME
04046-8104
US

IV. Provider business mailing address

8 HALL ST
KENNEBUNK ME
04043-7120
US

V. Phone/Fax

Practice location:
  • Phone: 781-608-3321
  • Fax:
Mailing address:
  • Phone: 781-608-3321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3969
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: