Healthcare Provider Details

I. General information

NPI: 1801030374
Provider Name (Legal Business Name): CHILD DEVELOPMENT SERVICES AROOSTOOK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 MAIN STREET
PRESQUE ISLE ME
04769
US

IV. Provider business mailing address

560 MAIN STREET
PRESQUE ISLE ME
04769
US

V. Phone/Fax

Practice location:
  • Phone: 207-764-4490
  • Fax: 207-769-2275
Mailing address:
  • Phone: 207-764-4490
  • Fax: 207-769-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: HOLLY J. PRESTON
Title or Position: DIRECTOR
Credential:
Phone: 207-764-4490