Provider Demographics
NPI:1225792351
Name:WOODFORD, SVITLANA (OT)
Entity Type:Individual
Prefix:
First Name:SVITLANA
Middle Name:
Last Name:WOODFORD
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 1:12 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1169
Mailing Address - Country:US
Mailing Address - Phone:559-930-5178
Mailing Address - Fax:
Practice Address - Street 1:12 GROVE ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1169
Practice Address - Country:US
Practice Address - Phone:559-930-5178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13313-AH-OT225X00000X
NH2945225X00000X
NY024201225X00000X
MEOT3718225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist