Healthcare Provider Details

I. General information

NPI: 1578778684
Provider Name (Legal Business Name): ERIN M DANDREA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 LITCHFIELD RD
SABATTUS ME
04280-4327
US

IV. Provider business mailing address

1104 LITCHFIELD RD
SABATTUS ME
04280-4327
US

V. Phone/Fax

Practice location:
  • Phone: 207-577-5960
  • Fax:
Mailing address:
  • Phone: 207-577-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT1510
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: