MEDICARE: TRACY LYNN PAYEUR MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT1775	ME

General Provider Information

NPI Number	:	1073804951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY LYNN PAYEUR MS, OTR/L

Provider Business Mailing Address
First Line	:	91 RIVER STREET
Second Line	:
City	:	SANFORD
State	:	ME
Zip	:	04073
Country	:	US
Telephone Number	:	207-432-7260
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 SHAW'S RIDGE RD
Second Line	:
City	:	SPRINGVALE
State	:	ME
Zip	:	04083-6207
Country	:	US
Telephone Number	:	207-432-7260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2011
Last Update Date	:	03/16/2012

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