Provider Demographics
NPI:1609123462
Name:OUTSIDE THE LINES, LLC
Entity Type:Organization
Organization Name:OUTSIDE THE LINES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL PEDIATRIC OT
Authorized Official - Prefix:MS
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:PRENDERGAST
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:207-286-6832
Mailing Address - Street 1:PO BOX 1772
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03821-1772
Mailing Address - Country:US
Mailing Address - Phone:207-286-6832
Mailing Address - Fax:866-702-2502
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:SUITE 140
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3882
Practice Address - Country:US
Practice Address - Phone:207-286-6832
Practice Address - Fax:866-702-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2020225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty