Healthcare Provider Details

I. General information

NPI: 1306284997
Provider Name (Legal Business Name): MEREDITH MERIN IVERS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PRESUMPSCOT ST
PORTLAND ME
04103-5225
US

IV. Provider business mailing address

112 OLD WOODMAN HILL RD
MINOT ME
04258-4625
US

V. Phone/Fax

Practice location:
  • Phone: 207-699-5531
  • Fax: 207-699-5529
Mailing address:
  • Phone: 207-333-0594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT2758
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: