Healthcare Provider Details

I. General information

NPI: 1215223342
Provider Name (Legal Business Name): ELIZABETH HUNTER MCDUFFIE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PRESUMPSCOT ST
PORTLAND ME
04103-5225
US

IV. Provider business mailing address

23 DRAKE ST
PORTLAND ME
04103-3815
US

V. Phone/Fax

Practice location:
  • Phone: 207-699-5531
  • Fax:
Mailing address:
  • Phone: 207-939-7112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2484
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: