Healthcare Provider Details

I. General information

NPI: 1669771119
Provider Name (Legal Business Name): ASHLEY ANNE JUAT MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 STONE ST STE 101
AUGUSTA ME
04330-5209
US

IV. Provider business mailing address

24 STONE ST STE 101
AUGUSTA ME
04330-5209
US

V. Phone/Fax

Practice location:
  • Phone: 207-582-8400
  • Fax: 207-230-6701
Mailing address:
  • Phone: 207-582-8400
  • Fax: 207-230-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number10375
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4763
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2879
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: