Healthcare Provider Details

I. General information

NPI: 1285033779
Provider Name (Legal Business Name): GENESIS REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WILSON ST
SKOWHEGAN ME
04976-2022
US

IV. Provider business mailing address

7 WILSON ST
SKOWHEGAN ME
04976-2022
US

V. Phone/Fax

Practice location:
  • Phone: 207-313-1419
  • Fax:
Mailing address:
  • Phone: 207-313-1419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberOA2639
License Number StateME

VIII. Authorized Official

Name: MARY ANNE TRACY
Title or Position: OCCUPATIONAL THERAPY ASSISTANT
Credential: COTA/L
Phone: 207-313-1419