Active NPI
Crystal Elizabeth Desjardins
- Occupational Therapist
- Lewiston, ME
National Provider Identifier
1962629121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT1690
- Practice address
- 102 Campus Avenue
Lewiston, ME 04240 - Phone
- (207) 777-4200
- NPI assigned
- Apr 19, 2007
- 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 | OT1690 | ME | Primary |
Addresses
Primary practice location
102 Campus Avenue
Lewiston, ME 04240
Mailing address
12 Grovemount Lane
Lewiston, ME 04240-4519
Phone (207) 786-5511
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 |
|---|---|---|---|
| OT1690 | ME | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962629121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 GROVEMOUNT LANE",
"city": "LEWISTON",
"state": "ME",
"postal_code": "042404519",
"telephone_number": "207-786-5511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 CAMPUS AVENUE",
"city": "LEWISTON",
"state": "ME",
"postal_code": "04240",
"telephone_number": "207-777-4200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESJARDINS",
"first_name": "CRYSTAL",
"middle_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "ME",
"license": "OT1690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lewiston, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.