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Organization
FUNCTIONAL HOME OT LLC
Active
Organization
FUNCTIONAL HOME OT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA ANNE LOPEZ OTR/L (OWNER)
(207) 548-5913
Entity
Organization
Contact information
Practice address
255 FIVE RD, CARMEL, ME 04419-3203
(207) 548-5913
Mailing address
255 FIVE RD, CARMEL, ME 04419-3203
(207) 745-4672
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
—
—
Other
Enumeration date
07/01/2020
Last updated
06/05/2023
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