Healthcare Provider Details

I. General information

NPI: 1356147367
Provider Name (Legal Business Name): THERAPY SHOPPE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 MAIN ST
MARS HILL ME
04758-0683
US

IV. Provider business mailing address

PO BOX 683
MARS HILL ME
04758-0683
US

V. Phone/Fax

Practice location:
  • Phone: 207-227-2677
  • Fax:
Mailing address:
  • Phone: 207-810-4579
  • Fax: 207-425-1036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CANDACE MIRIAM DONOVAN
Title or Position: OWNER
Credential: OT/L
Phone: 207-227-2677