Provider Demographics
NPI:1871828707
Name:KANE, DEANA MICHELINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:MICHELINE
Last Name:KANE
Suffix:
Gender:F
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:PO BOX 2303
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-2303
Mailing Address - Country:US
Mailing Address - Phone:207-933-2499
Mailing Address - Fax:866-697-9602
Practice Address - Street 1:475 PLEASANT ST STE 23
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3951
Practice Address - Country:US
Practice Address - Phone:207-333-3678
Practice Address - Fax:207-333-3679
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT516225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME403920099Medicaid