Provider Demographics
NPI:1528636115
Name:STANWOOD, DESIREE MARCELLIS (OTR)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:MARCELLIS
Last Name:STANWOOD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILBRIDGE
Mailing Address - State:ME
Mailing Address - Zip Code:04658-3413
Mailing Address - Country:US
Mailing Address - Phone:207-546-2880
Mailing Address - Fax:
Practice Address - Street 1:4 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:MILBRIDGE
Practice Address - State:ME
Practice Address - Zip Code:04658-3542
Practice Address - Country:US
Practice Address - Phone:207-546-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT4118225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist