Healthcare Provider Details

I. General information

NPI: 1447186432
Provider Name (Legal Business Name): AMY RUTH GERRITSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CUMBERLAND PL STE 122
BANGOR ME
04401-5090
US

IV. Provider business mailing address

1 CUMBERLAND PL STE 122
BANGOR ME
04401-5090
US

V. Phone/Fax

Practice location:
  • Phone: 207-300-4321
  • Fax: 844-520-1784
Mailing address:
  • Phone: 207-300-4321
  • Fax: 844-520-1784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT5020
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: