Provider Demographics
NPI:1932215605
Name:FAIRBANKS, LINDA ROSE (OTR)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ROSE
Last Name:FAIRBANKS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WOODBURY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3206
Mailing Address - Country:US
Mailing Address - Phone:603-812-5300
Mailing Address - Fax:603-501-0524
Practice Address - Street 1:100 WOODBURY AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3206
Practice Address - Country:US
Practice Address - Phone:603-812-5300
Practice Address - Fax:603-501-0524
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1008225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH13Y004093NH01OtherANTHEM
NH626422OtherHARVARD PILGRIM
NH30411785Medicaid
NH550954OtherCIGNA
NH2958253OtherAETNA
NH550954OtherCIGNA