Healthcare Provider Details

I. General information

NPI: 1982930657
Provider Name (Legal Business Name): SPURWINK SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 OCEAN AVE
PORTLAND ME
04103-2701
US

IV. Provider business mailing address

899 RIVERSIDE ST
PORTLAND ME
04103-1070
US

V. Phone/Fax

Practice location:
  • Phone: 207-871-1200
  • Fax: 207-871-1232
Mailing address:
  • Phone: 207-871-1200
  • Fax: 207-871-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number229881
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number229881
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number229881
License Number StateME

VIII. Authorized Official

Name: ERIC MEYER
Title or Position: PRESIDENT
Credential: LCSW
Phone: 207-871-1200