Active NPI
Elizabeth Brousseau
- Occupational Therapy Assistant
- Windham, ME
National Provider Identifier
1093023764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OA979
- Practice address
- 404 Gray Rd
Windham, ME 04062-4290 - Phone
- (207) 892-1840
- NPI assigned
- Sep 16, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OA979 | ME | Primary |
Addresses
Primary practice location
404 Gray Rd
Windham, ME 04062-4290
Mailing address
404 Gray Rd
Windham, ME 04062-4290
Phone (207) 892-1840
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OA979 | Other | ME | STATE OF MAINE BOARD OF OCCUPATIONAL THERAPY PRACTICE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OA979 | ME | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284595200000",
"number": "1093023764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 GRAY RD",
"city": "WINDHAM",
"state": "ME",
"postal_code": "040624290",
"telephone_number": "207-892-1840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 GRAY RD",
"city": "WINDHAM",
"state": "ME",
"postal_code": "040624290",
"telephone_number": "207-892-1840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSEAU",
"first_name": "ELIZABETH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-09-16",
"last_updated": "2010-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "ME",
"license": "OA979",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF MAINE BOARD OF OCCUPATIONAL THERAPY PRACTICE",
"identifier": "OA979",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Windham, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.