Provider Demographics
NPI:1124787189
Name:PITLUCK, MAURA E (OT)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:E
Last Name:PITLUCK
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SHAPE DR
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6760
Mailing Address - Country:US
Mailing Address - Phone:207-662-5143
Mailing Address - Fax:207-661-8104
Practice Address - Street 1:4 SHAPE DR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6760
Practice Address - Country:US
Practice Address - Phone:207-662-5143
Practice Address - Fax:207-661-8104
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT4608225XP0200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty