Provider Demographics
NPI:1477755395
Name:LIVONIUS, ROSA SYLVIA (OT)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:SYLVIA
Last Name:LIVONIUS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:SYLVIA
Other - Last Name:STEFANSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:56 STATION RD
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:ME
Mailing Address - Zip Code:04434-3033
Mailing Address - Country:US
Mailing Address - Phone:207-269-3461
Mailing Address - Fax:
Practice Address - Street 1:700 MOUNT HOPE AVE STE 320
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5680
Practice Address - Country:US
Practice Address - Phone:207-941-2952
Practice Address - Fax:207-941-2955
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT77225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist