Provider Demographics
NPI:1306284997
Name:IVERS, MEREDITH MERIN (OTR/L)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:MERIN
Last Name:IVERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 OLD WOODMAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ME
Mailing Address - Zip Code:04258-4625
Mailing Address - Country:US
Mailing Address - Phone:207-333-0594
Mailing Address - Fax:
Practice Address - Street 1:125 PRESUMPSCOT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5225
Practice Address - Country:US
Practice Address - Phone:207-699-5531
Practice Address - Fax:207-699-5529
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2758225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics