Basic Information
| Provider Information | |||||||||
| NPI: | 1073010377 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORMIER | ||||||||
| FirstName: | LACEY | ||||||||
| MiddleName: | BETH | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1457 BEECH HILL RD | ||||||||
| Address2: | |||||||||
| City: | MERCER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049574851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073576741 | ||||||||
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| Practice Location | |||||||||
| Address1: | 119 LIVERMORE FALLS RD | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049386241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077786591 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2018 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0019X | OT2381 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No ID Information.