Provider Demographics
NPI:1053680652
Name:YEATON, JUDITH (MS, OT/L)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:YEATON
Suffix:
Gender:F
Credentials:MS, OT/L
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:YEATON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, OT/L
Mailing Address - Street 1:91 CAMDEN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2455
Mailing Address - Country:US
Mailing Address - Phone:207-594-5933
Mailing Address - Fax:
Practice Address - Street 1:91 CAMDEN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2455
Practice Address - Country:US
Practice Address - Phone:207-594-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT52225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics