Healthcare Provider Details

I. General information

NPI: 1659424380
Provider Name (Legal Business Name): JAIME STOREY KIESOW OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAIME LYNN STOREYSMITH OTR/L

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 US ROUTE 1 STE 100
FALMOUTH ME
04105-2152
US

IV. Provider business mailing address

170 US ROUTE 1 STE 100
FALMOUTH ME
04105-2152
US

V. Phone/Fax

Practice location:
  • Phone: 207-781-0022
  • Fax: 207-781-0025
Mailing address:
  • Phone: 207-781-0022
  • Fax: 207-781-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT1178
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: