Healthcare Provider Details

I. General information

NPI: 1003783663
Provider Name (Legal Business Name): PEYTON ELIZABETH GOSSELIN OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SHUMAN AVE STE 16
AUGUSTA ME
04330-6020
US

IV. Provider business mailing address

76 BOWDOINHAM RD
LISBON FALLS ME
04252-6155
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-3900
  • Fax: 207-480-1541
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberTO4900
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: