Provider Demographics
NPI:1518171396
Name:SPECTRUM OCCUPATIONAL THERAPY SERVICES
Entity Type:Organization
Organization Name:SPECTRUM OCCUPATIONAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:207-933-2499
Mailing Address - Street 1:PO BOX 2303
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-2303
Mailing Address - Country:US
Mailing Address - Phone:207-933-2499
Mailing Address - Fax:207-933-2504
Practice Address - Street 1:392 US ROUTE 202
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04259
Practice Address - Country:US
Practice Address - Phone:207-933-2499
Practice Address - Fax:207-933-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME403920099Medicaid