Provider Demographics
NPI:1356743850
Name:TERPOORTEN, VICKY
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:TERPOORTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:ME
Mailing Address - Zip Code:04986-4211
Mailing Address - Country:US
Mailing Address - Phone:207-322-1856
Mailing Address - Fax:
Practice Address - Street 1:6A LIONS WAY
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6666
Practice Address - Country:US
Practice Address - Phone:207-338-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2942225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist