Healthcare Provider Details

I. General information

NPI: 1205039575
Provider Name (Legal Business Name): BARBARA MACDONALD CROMMETT O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SAUNDERS WAY
WESTBROOK ME
04092-4833
US

IV. Provider business mailing address

1866 HARPSWELL NECK RD
HARPSWELL ME
04079-3323
US

V. Phone/Fax

Practice location:
  • Phone: 207-878-9663
  • Fax: 207-878-2259
Mailing address:
  • Phone: 207-833-5755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT37
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: