Provider Demographics
NPI:1003142134
Name:BUBIER, JACALYN DAWN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JACALYN
Middle Name:DAWN
Last Name:BUBIER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MAY ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2923
Mailing Address - Country:US
Mailing Address - Phone:207-282-4138
Mailing Address - Fax:207-282-8242
Practice Address - Street 1:10 MAY ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2923
Practice Address - Country:US
Practice Address - Phone:207-282-4138
Practice Address - Fax:207-282-8242
Is Sole Proprietor?:No
Enumeration Date:2009-10-24
Last Update Date:2009-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME939225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist