Provider Demographics
NPI:1942765805
Name:ACKLEY, LAURA MARIE (OTR)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1398
Mailing Address - Country:US
Mailing Address - Phone:207-454-2544
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1398
Practice Address - Country:US
Practice Address - Phone:207-454-2544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3526225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist