Healthcare Provider Details

I. General information

NPI: 1699871079
Provider Name (Legal Business Name): JESSICA MARIE HYDE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
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

513 MOUNTFORT RD
NORTH YARMOUTH ME
04097-6920
US

V. Phone/Fax

Practice location:
  • Phone: 207-781-4830
  • Fax:
Mailing address:
  • Phone: 207-829-3728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT1628
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: