Provider Demographics
NPI:1609322106
Name:LEWIS, EMILY (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 NEW PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1542
Mailing Address - Country:US
Mailing Address - Phone:207-222-8955
Mailing Address - Fax:207-839-8263
Practice Address - Street 1:50 NEW PORTLAND RD
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1542
Practice Address - Country:US
Practice Address - Phone:207-839-5757
Practice Address - Fax:207-839-3716
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3241225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist