Healthcare Provider Details

I. General information

NPI: 1174948913
Provider Name (Legal Business Name): ERIN MASTERSON MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 OCEAN ST
SOUTH PORTLAND ME
04106-6615
US

IV. Provider business mailing address

483 OCEAN ST
SOUTH PORTLAND ME
04106-6615
US

V. Phone/Fax

Practice location:
  • Phone: 207-233-0976
  • Fax:
Mailing address:
  • Phone: 207-233-0976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number2621
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: