Healthcare Provider Details

I. General information

NPI: 1720869514
Provider Name (Legal Business Name): CONSTANCE E O'BRIENT OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MARTIN LN
BELFAST ME
04915-6099
US

IV. Provider business mailing address

396 GOOSEPECKER RIDGE RD
MONTVILLE ME
04941-4009
US

V. Phone/Fax

Practice location:
  • Phone: 207-930-7037
  • Fax: 207-793-0721
Mailing address:
  • Phone: 207-216-5277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT1282
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: