Jacqueline Awalt, COTA/L

Individual provider Active NPI Occupational Therapy Assistant · Oakland, ME

NPI 1992308365 · NPPES record last updated Nov 18, 2020

Key facts

NPI
1992308365
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
OA3984 (ME)
Practice address
840 Kennedy Memorial Dr
Oakland, ME 04963-4887
Phone
(207) 716-1863
NPI assigned
Nov 18, 2020
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
OA3984MEMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Gallant Therapy Services Past
since Nov 22, 2020
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X OA3984 ME Yes

Addresses

Primary practice location

840 Kennedy Memorial Dr
Oakland, ME 04963-4887

Mailing address

840 Kennedy Memorial Dr
Oakland, ME 04963-4887

Other providers in Oakland, ME

All providers in Oakland, ME · Occupational Therapy Assistant in Maine

Sources for this page

Verify at the official NPI Registry.