Provider Demographics
NPI:1104486182
Name:FOSTER, MARIA SEVERINO
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:SEVERINO
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 STILLWATER DR UNIT 16
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2468
Mailing Address - Country:US
Mailing Address - Phone:207-653-9723
Mailing Address - Fax:
Practice Address - Street 1:26 STILLWATER DR UNIT 16
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2468
Practice Address - Country:US
Practice Address - Phone:207-653-9723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT26667225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist