Provider Demographics
NPI:1366659674
Name:DEARBORN, TRACEY LEE-ANNE (MOTR L)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:LEE-ANNE
Last Name:DEARBORN
Suffix:
Gender:F
Credentials:MOTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 RIDGE RD APT 2
Mailing Address - Street 2:
Mailing Address - City:BOWDOINHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04008-5200
Mailing Address - Country:US
Mailing Address - Phone:207-666-3260
Mailing Address - Fax:
Practice Address - Street 1:20 BARROWS ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3214
Practice Address - Country:US
Practice Address - Phone:207-319-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1573225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist