Basic Information
| Provider Information | |||||||||
| NPI: | 1699016998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAW | ||||||||
| FirstName: | DARETH | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 189 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041022909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077746273 | ||||||||
| FaxNumber: | 2077740679 | ||||||||
| Practice Location | |||||||||
| Address1: | 189 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041022909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077746273 | ||||||||
| FaxNumber: | 2077740679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2013 | ||||||||
| LastUpdateDate: | 03/12/2013 | ||||||||
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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 | 225XL0004X | OT1419 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision |
No ID Information.