Provider Demographics
NPI:1851410054
Name:O.T. TO PLAY
Entity Type:Organization
Organization Name:O.T. TO PLAY
Other - Org Name:O.T. TO LEARN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEAUCHESNE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:207-739-2242
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:WEST PARIS
Mailing Address - State:ME
Mailing Address - Zip Code:04289-0051
Mailing Address - Country:US
Mailing Address - Phone:207-739-2242
Mailing Address - Fax:207-739-2466
Practice Address - Street 1:18 GROVE ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5610
Practice Address - Country:US
Practice Address - Phone:207-739-2242
Practice Address - Fax:207-739-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1234103TM1800X
224Z00000X, 225X00000X, 251C00000X
MESP322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME134830000Medicaid
ME433373200Medicaid
ME134830100Medicaid
ME433961000Medicaid
ME134830000Medicaid