MEDICARE: MRS. LAURA E HOUDLETTE 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	OT1449	ME

General Provider Information

NPI Number	:	1194136135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA E HOUDLETTE OTR/L

Provider Business Mailing Address
First Line	:	16 TANGLEWOOD DR
Second Line	:
City	:	KENNEBUNK
State	:	ME
Zip	:	04043-6307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 ELM ST
Second Line	:
City	:	NORTH BERWICK
State	:	ME
Zip	:	03906-6724
Country	:	US
Telephone Number	:	207-676-2242
Fax Number	:

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

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	05/13/2014

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