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General NPI Number Information
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NPI Number | 1417830399
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Entity Type | Individual
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Provider Name | LILY BERNTSSON MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 775 N MAIN ST
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City | WINTERPORT
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State | ME
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Zip | 04496-3414
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Country | US
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Telephone | 207-613-6494
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Fax | 401-329-3874
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Provider Business Mailing Address
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Address Line | 43 GLENWOOD DR APT 2
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City | BANGOR
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State | ME
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Zip | 04401-2981
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Country | US
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Telephone | 207-852-2375
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT4861
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License Number State | ME
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