Individual
MS. MIRELA LIANA SASUCLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, MOT,OTR/L
Contact information
Practice address
11 MERRYFIELD AVE, WATERVILLE, ME 04901-5139
(207) 873-7591
Mailing address
11 MERRYFIELD AVE, WATERVILLE, ME 04901-5139
(207) 873-7591
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT1172
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027504
ANTHEM
ME
01
—
03036
EBPA
ME
05
—
199590000
—
ME
Enumeration date
08/13/2006
Last updated
06/03/2021
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