MEDICARE: PEDIATRIC OCCUPATIONAL THERAPY SERVICES

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	225XP0200X	Pediatric Occupational Therapist	OT1733	ME

General Provider Information

NPI Number	:	1083887905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC OCCUPATIONAL THERAPY SERVICES

Provider Business Mailing Address
First Line	:	13 WESTMINSTER ST
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04240-3531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 WESTMINSTER ST
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04240-3531
Country	:	US
Telephone Number	:	207-783-3500
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	LISA MARIE COTE
Credential	:
Telephone Number	:	207-783-3500

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	04/11/2008

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