Healthcare Provider Details

I. General information

NPI: 1780049742
Provider Name (Legal Business Name): BRITTNEY JOY POULIN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WASHINGTON RD
RYE NH
03870-2318
US

IV. Provider business mailing address

1045 BRIDGTON RD
WESTBROOK ME
04092-2502
US

V. Phone/Fax

Practice location:
  • Phone: 603-964-8144
  • Fax:
Mailing address:
  • Phone: 207-333-1534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2510
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3089
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: