Provider Demographics
NPI:1346533411
Name:LARIVIERE, DONNA ELAINE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:DONNA
Middle Name:ELAINE
Last Name:LARIVIERE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:WEST KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04094-0558
Mailing Address - Country:US
Mailing Address - Phone:207-499-0080
Mailing Address - Fax:207-499-2597
Practice Address - Street 1:995 GOODWINS MILLS RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:ME
Practice Address - Zip Code:04005-7348
Practice Address - Country:US
Practice Address - Phone:207-499-0080
Practice Address - Fax:207-499-2597
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME1490172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker