Healthcare Provider Details

I. General information

NPI: 1588334015
Provider Name (Legal Business Name): LINDSEY ELISE KOUSAIE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 PORTLAND RD SUITE 10
ARUNDEL ME
04046
US

IV. Provider business mailing address

51 MEADOWLARK DR
YORK ME
03909-5849
US

V. Phone/Fax

Practice location:
  • Phone: 207-337-1058
  • Fax:
Mailing address:
  • Phone: 207-717-4554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT4154
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: