Provider Demographics
NPI:1104371772
Name:FIELDS, TATSIANA (OT)
Entity Type:Individual
Prefix:
First Name:TATSIANA
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:ME
Mailing Address - Zip Code:04434-3814
Mailing Address - Country:US
Mailing Address - Phone:207-631-5152
Mailing Address - Fax:
Practice Address - Street 1:158 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:ME
Practice Address - Zip Code:04434-3814
Practice Address - Country:US
Practice Address - Phone:207-631-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA3191174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist