Provider Demographics
NPI:1184941163
Name:CAOUETTE, BRENDA A (OTR/L)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:A
Last Name:CAOUETTE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:A
Other - Last Name:DIONNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:24 ANDERSEN RD
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071-6809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:146 STATE HOUSE STA
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04333-5921
Practice Address - Country:US
Practice Address - Phone:207-743-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT575225X00000X, 261QR0400X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation