Provider Demographics
NPI:1265639215
Name:RICHARDSON, ADAM NEAL (OT)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:NEAL
Last Name:RICHARDSON
Suffix:
Gender:M
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 BERNADETTE ST
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-2038
Mailing Address - Country:US
Mailing Address - Phone:207-498-3102
Mailing Address - Fax:
Practice Address - Street 1:10 BERNADETTE ST
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2038
Practice Address - Country:US
Practice Address - Phone:207-498-3102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME350052225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist