Provider Demographics
NPI:1043226566
Name:CYR, TIMOTHY L (OT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:CYR
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-0386
Mailing Address - Country:US
Mailing Address - Phone:207-551-8383
Mailing Address - Fax:
Practice Address - Street 1:108 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1576
Practice Address - Country:US
Practice Address - Phone:207-834-3481
Practice Address - Fax:207-834-7357
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT276225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME134990099Medicaid
ME035295OtherANTHEM INDIVIDUAL ID#