Basic Information
| Provider Information | |||||||||
| NPI: | 1386711562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | MAREN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.A., OTL | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | NAGEM | ||||||||
| OtherFirstName: | MAREN | ||||||||
| OtherMiddleName: | NELSON | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 217 LONGWOODS RD | ||||||||
| Address2: | |||||||||
| City: | FALMOUTH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041052608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077679773 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2 DAVIS POINT LN UNIT 1A | ||||||||
| Address2: | |||||||||
| City: | CAPE ELIZABETH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041072628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077679773 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 01/12/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT446 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.