Healthcare Provider Details

I. General information

NPI: 1972349900
Provider Name (Legal Business Name): MELISSA HOTHAM OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 VAN BUREN RD STE 1
CARIBOU ME
04736-3588
US

IV. Provider business mailing address

PO BOX 40
CARIBOU ME
04736-0040
US

V. Phone/Fax

Practice location:
  • Phone: 207-498-3111
  • Fax:
Mailing address:
  • Phone: 207-498-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT4467
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: