Healthcare Provider Details

I. General information

NPI: 1164691309
Provider Name (Legal Business Name): LADAWN THERAPEUTIC RIDING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 GOODWINS MILLS RD
DAYTON ME
04005-7348
US

IV. Provider business mailing address

PO BOX 558
WEST KENNEBUNK ME
04094-0558
US

V. Phone/Fax

Practice location:
  • Phone: 207-499-0080
  • Fax:
Mailing address:
  • Phone: 207-499-0080
  • Fax: 207-499-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberOT1490
License Number StateME

VIII. Authorized Official

Name: MS. DONNA E LARIVIERE
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 207-490-0080