MEDICARE: LORIE B WYMAN 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	225XP0200X	Pediatric Occupational Therapist	304	ME

General Provider Information

NPI Number	:	1366409351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORIE B WYMAN OTR/L

Provider Business Mailing Address
First Line	:	17 SPILLER DR
Second Line	:
City	:	KENNEBUNK
State	:	ME
Zip	:	04043-6808
Country	:	US
Telephone Number	:	207-985-5821
Fax Number	:

Provider Business Practice Location Address
First Line	:	1236 PORTLAND RD
Second Line	:
City	:	ARUNDEL
State	:	ME
Zip	:	04046-8104
Country	:	US
Telephone Number	:	207-468-1293
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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