1538183876 NPI number — MRS. DEBORA MARIE BADGER OCCUPATIONAL THERAPI

Table of content: MS. AVIA ANDERSON (NPI 1932772142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538183876 NPI number — MRS. DEBORA MARIE BADGER OCCUPATIONAL THERAPI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADGER
Provider First Name:
DEBORA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OCCUPATIONAL THERAPI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BADGER
Provider Other First Name:
DEBBIE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1538183876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
53 GRAY BIRCH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04027-3324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-475-3255
Provider Business Mailing Address Fax Number:
207-457-1525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1068 MAIN ST
Provider Second Line Business Practice Location Address:
DUNHAM STREET
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04073-3606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-475-3255
Provider Business Practice Location Address Fax Number:
207-457-1525
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X , with the licence number:  OT1321 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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