Provider Demographics
NPI:1487868287
Name:IRELAND, LAURIE JAYNE (COTA L)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:JAYNE
Last Name:IRELAND
Suffix:
Gender:F
Credentials:COTA L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 CURTIS RD
Mailing Address - Street 2:
Mailing Address - City:SWANVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4553
Mailing Address - Country:US
Mailing Address - Phone:207-338-2315
Mailing Address - Fax:
Practice Address - Street 1:6 MORTLAND RD
Practice Address - Street 2:
Practice Address - City:SEARSPORT
Practice Address - State:ME
Practice Address - Zip Code:04974-3332
Practice Address - Country:US
Practice Address - Phone:207-548-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA844224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant