=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316131618
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THAYER MCCAIN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2007
-----------------------------------------------------
Last Update Date | 11/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 MAPLE ST
-----------------------------------------------------
City | SACO
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04072-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-571-8148
-----------------------------------------------------
Fax | 978-517-4201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 MAPLE ST
-----------------------------------------------------
City | SACO
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04072-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-571-8148
-----------------------------------------------------
Fax | 978-517-4201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | THAYER MCCAIN
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 207-571-8148
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT1410
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 2079
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------