Healthcare Provider Details

I. General information

NPI: 1487182689
Provider Name (Legal Business Name): OTIS SCHOOL DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 OTIS RD
OTIS ME
04605-6703
US

IV. Provider business mailing address

105 OTIS ROAD BEECH HILL SCHOOL
OTIS ME
04605
US

V. Phone/Fax

Practice location:
  • Phone: 207-537-2203
  • Fax: 207-537-3127
Mailing address:
  • Phone: 207-537-2203
  • Fax: 207-537-3127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. BRUCE ERIC BRETTSCHNEIDER
Title or Position: SPECIAL EDUCATION DIRECTOR
Credential: M.ED
Phone: 207-537-2203