Basic Information
| Provider Information | |||||||||
| NPI: | 1285386904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARSEN | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | BUGBEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 BEACON HILL RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHPORT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045763045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073807055 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 35 MILES ST | ||||||||
| Address2: | |||||||||
| City: | DAMARISCOTTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045434047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075631234 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2022 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT3523 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.