Mary Elizabeth Wagstaff, OTR/L

Primary specialty

Gerontology Occupational TherapistTaxonomy code 225XG0600X

License

OT955 Issued in ME

Practice address

Seaport Village Healthcare
19 General Moore Way
Ellsworth, ME 04605

Phone

(207) 667-9336

NPI assigned

Mar 12, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1552348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586995200000",
    "number": "1760940464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 UPLAND WAY",
            "city": "ELLSWORTH",
            "state": "ME",
            "postal_code": "046053475",
            "telephone_number": "207-266-4396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SEAPORT VILLAGE HEALTHCARE",
            "address_2": "19 GENERAL MOORE WAY",
            "city": "ELLSWORTH",
            "state": "ME",
            "postal_code": "04605",
            "telephone_number": "207-667-9336"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "587 N Deer Isle Rd",
            "address_purpose": "LOCATION",
            "city": "Deer Isle",
            "state": "ME",
            "postal_code": "046273438",
            "country_code": "US",
            "telephone_number": "855-390-7774",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGSTAFF",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-12",
        "last_updated": "2020-04-16",
        "certification_date": "2020-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XG0600X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Gerontology",
            "state": "ME",
            "license": "OT955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Occupational Therapist in Ellsworth, ME
• Providers in Ellsworth, ME by specialty
• Gerontology Occupational Therapist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2020; 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.