Provider Demographics
NPI:1376734665
Name:ASTROSKY, MERIDYTH R (OTRL)
Entity Type:Individual
Prefix:
First Name:MERIDYTH
Middle Name:R
Last Name:ASTROSKY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:MERIDYTH
Other - Middle Name:ANN
Other - Last Name:RAUSCHKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:26 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2912
Mailing Address - Country:US
Mailing Address - Phone:207-761-8402
Mailing Address - Fax:207-761-8460
Practice Address - Street 1:26 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2912
Practice Address - Country:US
Practice Address - Phone:207-761-8402
Practice Address - Fax:207-761-8460
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT479225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME024747OtherANTHEM
ME024747OtherANTHEM