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General NPI Number Information
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NPI Number | 1053273425
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Entity Type | Individual
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Provider Name | ERIC JAMES EGDORF OTR/L
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Gender | Male
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 50 NEW PORTLAND RD
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City | GORHAM
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State | ME
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Zip | 04038-1542
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Country | US
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Telephone | 602-377-7932
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Fax |
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Provider Business Mailing Address
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Address Line | 42 WASHINGTON AVE APT 2
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City | OLD ORCHARD BEACH
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State | ME
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Zip | 04064-2156
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Country | US
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Telephone | 602-377-7932
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | OT4671
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License Number State | ME
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