Provider Demographics
NPI:1346699717
Name:DUDLEY, ELISABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:P
Other - Last Name:DUDLEY-BEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-0245
Mailing Address - Country:US
Mailing Address - Phone:207-271-0103
Mailing Address - Fax:
Practice Address - Street 1:1020 SACARAP RD
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:ME
Practice Address - Zip Code:04643-3224
Practice Address - Country:US
Practice Address - Phone:207-271-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2631225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist