Provider Demographics
NPI:1356870497
Name:HAVEY, EMILY TATE (OTR/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:TATE
Last Name:HAVEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:ME
Mailing Address - Zip Code:04634-3105
Mailing Address - Country:US
Mailing Address - Phone:207-565-5118
Mailing Address - Fax:
Practice Address - Street 1:1611 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:ME
Practice Address - Zip Code:04643-3038
Practice Address - Country:US
Practice Address - Phone:207-460-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist