Healthcare Provider Details

I. General information

NPI: 1962868869
Provider Name (Legal Business Name): BRIAN SHERMAN MS OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PRESUMPSCOT ST
PORTLAND ME
04103-5225
US

IV. Provider business mailing address

125 PRESUMPSCOT ST
PORTLAND ME
04103-5225
US

V. Phone/Fax

Practice location:
  • Phone: 207-699-5531
  • Fax: 207-699-5529
Mailing address:
  • Phone: 207-699-5531
  • Fax: 207-699-5529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3114
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: