MEDICARE: KELLY CAROLINA PITRE 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	OT4016	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912557000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY CAROLINA PITRE OTR/L

Provider Business Mailing Address
First Line	:	554 MAIN ST UNIT 2
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-5407
Country	:	US
Telephone Number	:	305-323-7418
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 MIDDLE RD
Second Line	:
City	:	FALMOUTH
State	:	ME
Zip	:	04105-1817
Country	:	US
Telephone Number	:	305-323-7418
Fax Number	:

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

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	05/30/2024

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