Provider Demographics
NPI:1811552185
Name:GILBERT, NICHOLAS (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:GILBERT
Suffix:
Gender:M
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 1:5 PONDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-2223
Mailing Address - Country:US
Mailing Address - Phone:207-754-6459
Mailing Address - Fax:
Practice Address - Street 1:440 MINOT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4332
Practice Address - Country:US
Practice Address - Phone:207-784-3573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3624225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEOT3624OtherSTATE OF MAINE DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
414410OtherNBCOT