Healthcare Provider Details

I. General information

NPI: 1326649062
Provider Name (Legal Business Name): ALYSSA FABIANEK OTD, OTR/L, CBIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2020
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST
LEWISTON ME
04240-7041
US

IV. Provider business mailing address

16 LIBBY RD
MINOT ME
04258-5448
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-0111
  • Fax:
Mailing address:
  • Phone: 978-888-3659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT4431
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: