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Individual

MICHELLE FORBES SUMMERVILLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
COASTAL KIDS OT 1222 PORTLAND RD, ARUNDEL, ME 04046
(207) 337-1058
Mailing address
77 ROBERTS POND RD, LYMAN, ME 04002-6714
(207) 544-3925

Taxonomy

Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
PA4434
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PA4434
LICENSE
ME
Enumeration date
04/21/2022
Last updated
04/21/2022
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