Provider Demographics
NPI:1205039575
Name:CROMMETT, BARBARA MACDONALD (OT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:MACDONALD
Last Name:CROMMETT
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 1:1866 HARPSWELL NECK RD
Mailing Address - Street 2:
Mailing Address - City:HARPSWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04079-3323
Mailing Address - Country:US
Mailing Address - Phone:207-833-5755
Mailing Address - Fax:
Practice Address - Street 1:15 SAUNDERS WAY
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4833
Practice Address - Country:US
Practice Address - Phone:207-878-9663
Practice Address - Fax:207-878-2259
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT37225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME213500000Medicaid