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General NPI Number Information
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NPI Number | 1164208427
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Entity Type | Individual
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Provider Name | MICHAEL SEVERANCE OTR/L
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Gender | Male
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 09/04/2023
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Provider Practice Location Address
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Address Line | 758 BROADWAY
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City | BANGOR
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State | ME
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Zip | 04401-3224
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Country | US
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Telephone | 207-941-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 3875 UNION ST APT C
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City | LEVANT
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State | ME
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Zip | 04456-4499
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Country | US
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Telephone | 207-385-5053
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT4522
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License Number State | ME
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