Provider Demographics
NPI:1578878955
Name:DESPRES, MARIBEL SEDA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARIBEL
Middle Name:SEDA
Last Name:DESPRES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BLACKBERRY HILL ROAD
Mailing Address - Street 2:VIVIAN HUSSEY SCHOOL
Mailing Address - City:BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03901
Mailing Address - Country:US
Mailing Address - Phone:207-698-4465
Mailing Address - Fax:
Practice Address - Street 1:21 MAIN STREET
Practice Address - Street 2:SAD 60
Practice Address - City:NORTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03906
Practice Address - Country:US
Practice Address - Phone:207-698-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1253225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEOT1253Medicare PIN