Healthcare Provider Details

I. General information

NPI: 1851410054
Provider Name (Legal Business Name): O.T. TO PLAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 GROVE ST
NORWAY ME
04268-5610
US

IV. Provider business mailing address

PO BOX 51
WEST PARIS ME
04289-0051
US

V. Phone/Fax

Practice location:
  • Phone: 207-739-2242
  • Fax: 207-739-2466
Mailing address:
  • Phone: 207-739-2242
  • Fax: 207-739-2466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP322
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPS1234
License Number StateME
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CYNTHIA L BEAUCHESNE
Title or Position: CO OWNER
Credential: OTR/L
Phone: 207-739-2242