=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225329097
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAILIN E O'CONNOR LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2011
-----------------------------------------------------
Last Update Date | 01/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 884 BROADWAY
-----------------------------------------------------
City | SOUTH PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04106-4371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-409-5097
-----------------------------------------------------
Fax | 603-929-5958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11B CLIFF AVE
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03842
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone | 207-409-5097
-----------------------------------------------------
Fax | 603-929-5958
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT3994
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------