Healthcare Provider Details

I. General information

NPI: 1548828783
Provider Name (Legal Business Name): JORDYN N GELINEAU OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDYN HOPKINS

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 09/12/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 STILLWATER AVE
BANGOR ME
04401-3945
US

IV. Provider business mailing address

398 HAMILTON AVE
FAIRBANKS AK
99701-3537
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-6100
  • Fax:
Mailing address:
  • Phone: 907-374-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number158255
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberTO3691
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: