Individual
BRIAN WITHERELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
15 STRAWBERRY AVE, LEWISTON, ME 04240-5941
(207) 777-7740
Mailing address
40 ELM ST, JAY, ME 04239-1735
(681) 209-4285
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
C2059
WV
224Z00000X
Occupational Therapy Assistant
Primary
OA4088
ME
224Z00000X
Occupational Therapy Assistant
OP008369
PA
Other
Enumeration date
05/12/2017
Last updated
10/20/2023
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