Healthcare Provider Details

I. General information

NPI: 1477659878
Provider Name (Legal Business Name): DANIELLE ERIN PROUT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 US ROUTE 1
FALMOUTH ME
04105-1345
US

IV. Provider business mailing address

75 THORNTON AVE
SOUTH PORTLAND ME
04106-6128
US

V. Phone/Fax

Practice location:
  • Phone: 207-781-4830
  • Fax:
Mailing address:
  • Phone: 207-441-3352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT1898
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: