NPIMap

Organization Active NPI

Pediatric Development Center

  • Occupational Therapist
  • Westbrook, ME
National Provider Identifier
1720173321
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
PEDIATRIC DEVELOPMENT CENTER
Practice address
12 Westbrook CMN
Westbrook, ME 04092
Phone
(207) 591-7210
Fax
(207) 591-7213
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jillian R O'Brien, OTRLNPI 1386740777
Title
Owner
Phone
(207) 591-7210

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Occupational Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 224Z00000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary
Speech-Language AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 2355S0801X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

12 Westbrook CMN
Westbrook, ME 04092

Mailing address

12 Westbrook CMN
Westbrook, ME 04092-2819
Phone (207) 591-7210

Other practice location 1

15 Lund Rd Ste 106
Saco, ME 04072-1806
Phone (207) 591-7210

Other identifiers 1

IdentifierTypeStateIssuer
128690000MedicaidME

National Provider Directory

National Provider Directory

Locations

15 Lund Rd
Ste 106
Saco, ME 04072
Phone (207) 591-7210

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1720173321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 WESTBROOK CMN",
            "city": "WESTBROOK",
            "state": "ME",
            "postal_code": "040922819",
            "telephone_number": "207-591-7210",
            "fax_number": "207-591-7213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 WESTBROOK CMN",
            "city": "WESTBROOK",
            "state": "ME",
            "postal_code": "04092",
            "telephone_number": "207-591-7210",
            "fax_number": "207-591-7213"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15 Lund Rd Ste 106",
            "address_purpose": "LOCATION",
            "city": "Saco",
            "state": "ME",
            "postal_code": "040721806",
            "country_code": "US",
            "telephone_number": "207-591-7210",
            "fax_number": "207-591-7213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC DEVELOPMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "JILLIAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-591-7210",
        "authorized_official_credential": "OTRL"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2355S0801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128690000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westbrook, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 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.

Verify at the official NPI Registry.