Basic Information
| Provider Information | |||||||||
| NPI: | 1477755395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIVONIUS | ||||||||
| FirstName: | ROSA | ||||||||
| MiddleName: | SYLVIA | ||||||||
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| Credential: | OT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | STEFANSSON | ||||||||
| OtherFirstName: | ROSA | ||||||||
| OtherMiddleName: | SYLVIA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 56 STATION RD | ||||||||
| Address2: | |||||||||
| City: | ETNA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044343033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072693461 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 700 MOUNT HOPE AVE STE 320 | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044015680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079412952 | ||||||||
| FaxNumber: | 2079412955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 225X00000X | OT77 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.