Organization
PEDIATRIC DEVELOPMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILLIAN R O'BRIEN OTRL (OWNER)
(207) 591-7210
Entity
Organization
Contact information
Practice address
12 WESTBROOK CMN, WESTBROOK, ME 04092
(207) 591-7210
(207) 591-7213
Mailing address
12 WESTBROOK CMN, WESTBROOK, ME 04092-2819
(207) 591-7210
(207) 591-7213
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
Primary
—
—
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128690000
—
ME
Enumeration date
10/03/2006
Last updated
10/12/2023
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