Active NPI
Ann M Altavilla, O.T.
- Occupational Therapist
- Scarborough, ME
National Provider Identifier
1265419675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT1663
- Practice address
- 9 Equestrian Way
Scarborough, ME 04074-9628 - Phone
- (207) 229-8732
- NPI assigned
- Dec 28, 2005
- 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 Therapist | 225X00000X | OT1663 | ME | Primary |
Addresses
Primary practice location
9 Equestrian Way
Scarborough, ME 04074-9628
Mailing address
9 Equestrian Way
Scarborough, ME 04074-9628
Phone (207) 229-8732
Other practice location 1
146 State House Sta
Augusta, ME 04333-0146
Phone (207) 624-6660
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265419675 | Medicaid | ME | |
| 022858 | Other | ME | BC/BS |
| 1265419675 | Other | ME | HPHC |
| 3708377 | Other | ME | AETNA |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719705600000",
"number": "1265419675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 EQUESTRIAN WAY",
"city": "SCARBOROUGH",
"state": "ME",
"postal_code": "040749628",
"telephone_number": "207-229-8732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 EQUESTRIAN WAY",
"city": "SCARBOROUGH",
"state": "ME",
"postal_code": "040749628",
"telephone_number": "207-229-8732"
}
],
"practiceLocations": [
{
"address_1": "146 State House Sta",
"address_purpose": "LOCATION",
"city": "Augusta",
"state": "ME",
"postal_code": "043330146",
"country_code": "US",
"telephone_number": "207-624-6660",
"fax_number": "207-624-6661",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ALTAVILLA",
"first_name": "ANN",
"middle_name": "M",
"credential": "O.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-12-28",
"last_updated": "2024-06-30",
"certification_date": "2024-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "ME",
"license": "OT1663",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1265419675",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "022858",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HPHC",
"identifier": "1265419675",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "3708377",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Scarborough, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.