Provider Demographics
NPI:1033468541
Name:HESELTON, LAURIE L (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:L
Last Name:HESELTON
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 1:7 WINDING BROOKE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908-2184
Mailing Address - Country:US
Mailing Address - Phone:207-704-0014
Mailing Address - Fax:
Practice Address - Street 1:47 ELM ST
Practice Address - Street 2:
Practice Address - City:NORTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03906-6724
Practice Address - Country:US
Practice Address - Phone:207-676-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2277225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist