Basic Information
| Provider Information | |||||||||
| NPI: | 1073966891 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SOMMER | ||||||||
| FirstName: | LYDIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 RIVERSIDE ST UNIT 6B | ||||||||
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| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041031073 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 92 CAMPUS DR | ||||||||
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| City: | SCARBOROUGH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040747133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078850011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2016 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | OT3182 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.