Provider Demographics
NPI:1184058042
Name:TRAIL, DAVID BRIAN
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRIAN
Last Name:TRAIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SAMUEL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3621
Mailing Address - Country:US
Mailing Address - Phone:207-310-4685
Mailing Address - Fax:
Practice Address - Street 1:659 MORRIS ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-2639
Practice Address - Country:US
Practice Address - Phone:518-424-8921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
MAOA2900224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant