Active NPI
Lily Brianna Leavitt
- Occupational Therapist
- Bangor, ME
National Provider Identifier
1639954258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT4223
- Practice address
- 100 Moosehead Blvd
Bangor, ME 04401-2367 - Phone
- (207) 941-6240
- NPI assigned
- Aug 30, 2023
- Sex
- Female
- Sole proprietor
- No
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 | OT4223 | ME | Primary |
Addresses
Primary practice location
100 Moosehead Blvd
Bangor, ME 04401-2367
Mailing address
100 Moosehead Blvd
Bangor, ME 04401-2367
Phone (207) 941-6240
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 |
|---|---|---|---|
| OT4223 | ME | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693353600000",
"number": "1639954258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MOOSEHEAD BLVD",
"city": "BANGOR",
"state": "ME",
"postal_code": "044012367",
"telephone_number": "207-941-6240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MOOSEHEAD BLVD",
"city": "BANGOR",
"state": "ME",
"postal_code": "044012367",
"telephone_number": "207-941-6240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEAVITT",
"first_name": "LILY",
"middle_name": "BRIANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-30",
"last_updated": "2023-08-30",
"certification_date": "2023-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "ME",
"license": "OT4223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.