Michelle Forbes Summerville
Individual provider Active NPI Pediatric Neurodevelopmental Disabilities Physician · Arundel, ME
NPI 1245974708 · NPPES record last updated Apr 21, 2022
Key facts
- NPI
- 1245974708
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Neurodevelopmental Disabilities Physician 2080P0008X
- License
- PA4434 (ME)
- Practice address
- Coastal Kids OT 1222 Portland Rd
Arundel, ME 04046 - Phone
- (207) 337-1058
- NPI assigned
- Apr 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA4434 | ME | MD | Pediatric Neurodevelopmental Disabilities Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Kids Occupational Therapy | Current |
Accepting new patients | |
| Coastal Kids Occupational Therapy PLLC | Current |
Accepting new patients |
Locations
1222 Portland Rd
Arundel, ME 04046
Phone (207) 337-1058
Interoperability endpoints
- shelly@coastalmainekidsotmaine.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Neurodevelopmental Disabilities Physician | 2080P0008X | PA4434 | ME | Yes |
Addresses
Primary practice location
Coastal Kids OT 1222 Portland Rd
Arundel, ME 04046
Mailing address
77 Roberts Pond Rd
Lyman, ME 04002-6714
Phone (207) 544-3925
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA4434 | Other | ME | LICENSE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Shelly@coastalmainekidsotmaine.com | Direct |
Other providers in Arundel, ME
- Andrea Simoneau
- Judith L Smith
- Southern Maine TMS LLC
- Stickman Dialysis Industries
- Elizabeth Ann Straka
- Manal G Taleb
- Three Birches Health Services LLC
- Taylor Torcoletti
- Town of Arundel
- James William Trentalange
All providers in Arundel, ME · Pediatric Neurodevelopmental Disabilities Physician in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.