Healthcare Provider Details

I. General information

NPI: 1073747713
Provider Name (Legal Business Name): RIVER BIRCH OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2009
Last Update Date: 05/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 PORTLAND RD
ARUNDEL ME
04046-8104
US

IV. Provider business mailing address

1236 PORTLAND RD
ARUNDEL ME
04046-8104
US

V. Phone/Fax

Practice location:
  • Phone: 207-468-1293
  • Fax:
Mailing address:
  • Phone: 207-468-1293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT304
License Number StateME

VIII. Authorized Official

Name: MRS. LORIE B WYMAN
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 207-468-1293