Provider Demographics
NPI:1013285360
Name:FORTIER, KATIE M (OT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:FORTIER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARKET PLACE DR
Mailing Address - Street 2:UNIT 3B
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1680
Mailing Address - Country:US
Mailing Address - Phone:207-351-3078
Mailing Address - Fax:207-351-3083
Practice Address - Street 1:10 MARKET PLACE DR
Practice Address - Street 2:UNIT 3B
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1680
Practice Address - Country:US
Practice Address - Phone:207-351-3078
Practice Address - Fax:207-351-3083
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2361225X00000X
NHNH2105225X00000X
MAMA9922225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist