Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT284 | ME |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT284 | ME |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT284 | ME |
NPI | 1699909473 |
---|---|
Provider Name | Lisa Marie Ottman |
First Address | Kennebunkport, ME 04046-3064 |
Second Address | Kennebunk, ME 04043-7095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2009 |
Last Update Date | 08/05/2009 |