Healthcare Provider Details

I. General information

NPI: 1184926131
Provider Name (Legal Business Name): LINDSEY M O'DONOGHUE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2010
Last Update Date: 02/10/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LOVING KINDNESS WAY
YORK ME
03903
US

IV. Provider business mailing address

63B WILDBROOK LN
ELIOT ME
03903-1235
US

V. Phone/Fax

Practice location:
  • Phone: 207-363-4321
  • Fax:
Mailing address:
  • Phone: 508-789-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2151
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3056
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10194
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: