Provider Demographics
NPI:1477921518
Name:LEBEL, JEAN MARIE (OTL)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:LEBEL
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3125
Mailing Address - Country:US
Mailing Address - Phone:207-942-7336
Mailing Address - Fax:207-942-5225
Practice Address - Street 1:750 UNION ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3125
Practice Address - Country:US
Practice Address - Phone:207-942-7336
Practice Address - Fax:207-942-5225
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-07
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT823225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist