Healthcare Provider Details

I. General information

NPI: 1942516133
Provider Name (Legal Business Name): NATHAN LADD O.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 WEST RD
WATERBORO ME
04087-3209
US

IV. Provider business mailing address

86 WEST RD
WATERBORO ME
04087-3209
US

V. Phone/Fax

Practice location:
  • Phone: 207-247-3141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: