Provider Demographics
NPI:1982919320
Name:PROCTOR, SUE
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SUMMIT HILL RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:ME
Mailing Address - Zip Code:04040-3332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1570 MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:ME
Practice Address - Zip Code:04270-3390
Practice Address - Country:US
Practice Address - Phone:207-743-8972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1065225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist