Provider Demographics
NPI:1629853387
Name:MCKEIL, CARLY ANNE (COTA/L)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:ANNE
Last Name:MCKEIL
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 1:402 PRIEST HILL RD
Mailing Address - Street 2:
Mailing Address - City:VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04989
Mailing Address - Country:US
Mailing Address - Phone:207-831-3513
Mailing Address - Fax:
Practice Address - Street 1:8 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-1370
Practice Address - Country:US
Practice Address - Phone:207-453-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA4449224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant