Healthcare Provider Details

I. General information

NPI: 1649819632
Provider Name (Legal Business Name): HEATHER CHAMBERLAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COMMONS AVE STE A
WINDHAM ME
04062-5554
US

IV. Provider business mailing address

33 SEWALL ST
PORTLAND ME
04102-2638
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-2100
  • Fax: 207-553-7166
Mailing address:
  • Phone: 207-828-2100
  • Fax: 207-553-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOT3717
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: