Provider Demographics
NPI:1790907897
Name:GOSSELIN, LAURIE ANNA (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNA
Last Name:GOSSELIN
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANNA
Other - Last Name:CAOUETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:PO BOX 8600
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104
Mailing Address - Country:US
Mailing Address - Phone:207-774-6323
Mailing Address - Fax:207-761-8460
Practice Address - Street 1:618 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-795-6110
Practice Address - Fax:207-795-6189
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA0025224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant