Provider Demographics
NPI:1891009684
Name:EISNER, CAROLYN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:EISNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WESCOTT RD
Mailing Address - Street 2:SOUTH PORTLAND SCHOOL DEPARTMENT
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3420
Mailing Address - Country:US
Mailing Address - Phone:207-871-0555
Mailing Address - Fax:207-871-0559
Practice Address - Street 1:130 WESCOTT RD
Practice Address - Street 2:SOUTH PORTLAND SCHOOL DEPARTMENT
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3420
Practice Address - Country:US
Practice Address - Phone:207-871-0555
Practice Address - Fax:207-871-0559
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT30225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist