Provider Demographics
NPI:1235508524
Name:GILBERT, ALISHA (OTRL)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LEDGES CT
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-1851
Mailing Address - Country:US
Mailing Address - Phone:207-795-6110
Mailing Address - Fax:207-795-6189
Practice Address - Street 1:618 MAIN ST
Practice Address - Street 2:GOODWILL NEUROREHAB SERVICES
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-795-6110
Practice Address - Fax:207-795-6189
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3035174400000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty