Provider Demographics
NPI:1437826070
Name:ATLANTIC OCCUPATIONAL THERAPY
Entity type:Organization
Organization Name:ATLANTIC OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAMARIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-735-4625
Mailing Address - Street 1:926 STILLWATER AVE
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468-2146
Mailing Address - Country:US
Mailing Address - Phone:207-735-4625
Mailing Address - Fax:
Practice Address - Street 1:926 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-2146
Practice Address - Country:US
Practice Address - Phone:207-735-4625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty