Healthcare Provider Details

I. General information

NPI: 1184407983
Provider Name (Legal Business Name): ADRIENNE NOELLE BEATTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 PORTLAND RD STE B
KENNEBUNK ME
04043-6742
US

IV. Provider business mailing address

136 MEADERBORO RD
ROCHESTER NH
03867-4236
US

V. Phone/Fax

Practice location:
  • Phone: 207-849-5041
  • Fax:
Mailing address:
  • Phone: 603-833-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT4505
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: