Provider Demographics
NPI:1285073593
Name:SWEET SONG SERVICES
Entity type:Organization
Organization Name:SWEET SONG SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR, OT
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:S
Authorized Official - Last Name:ST. HILAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR/L
Authorized Official - Phone:207-240-7543
Mailing Address - Street 1:249 OLD DANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-8104
Mailing Address - Country:US
Mailing Address - Phone:207-240-7543
Mailing Address - Fax:
Practice Address - Street 1:249 OLD DANVILLE RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8104
Practice Address - Country:US
Practice Address - Phone:207-240-7543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMETPID005088Medicaid