Provider Demographics
NPI:1205007630
Name:LEVASSEUR, WHITNEY A (COTA/L)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:A
Last Name:LEVASSEUR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 NORFOLK ST
Mailing Address - Street 2:APT B
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4811
Mailing Address - Country:US
Mailing Address - Phone:207-974-9405
Mailing Address - Fax:
Practice Address - Street 1:33 BIRCH AVE
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1806
Practice Address - Country:US
Practice Address - Phone:207-667-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA1900224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant