Healthcare Provider Details

I. General information

NPI: 1821773763
Provider Name (Legal Business Name): DANDELION OCCUPATIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 GRANITE LEDGE LN
ORRINGTON ME
04474-3753
US

IV. Provider business mailing address

PO BOX 316
ORRINGTON ME
04474-0316
US

V. Phone/Fax

Practice location:
  • Phone: 207-991-3064
  • Fax:
Mailing address:
  • Phone: 207-814-7266
  • 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: MICHELLE METTLER
Title or Position: OWNER/THERAPIST
Credential: MS OTR/L
Phone: 207-814-7266