Provider Demographics
NPI:1992205249
Name:MAINE ASSISTIVE TECHNOLOGY SOLUTIONS
Entity Type:Organization
Organization Name:MAINE ASSISTIVE TECHNOLOGY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L, ATP
Authorized Official - Phone:207-321-1015
Mailing Address - Street 1:24 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-3229
Mailing Address - Country:US
Mailing Address - Phone:207-321-1015
Mailing Address - Fax:
Practice Address - Street 1:24 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-3229
Practice Address - Country:US
Practice Address - Phone:207-321-1015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA622224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty