Healthcare Provider Details

I. General information

NPI: 1255059200
Provider Name (Legal Business Name): THE COUNTY OT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 GRIFFIN RIDGE RD
MAPLETON ME
04757-4149
US

IV. Provider business mailing address

884 GRIFFIN RIDGE RD
MAPLETON ME
04757-4149
US

V. Phone/Fax

Practice location:
  • Phone: 207-227-6538
  • Fax:
Mailing address:
  • Phone: 207-227-6538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KASSIE JO LOVELY CLARK
Title or Position: OWNER
Credential: MS,OTR/L
Phone: 207-227-6538