Provider Demographics
NPI:1326376955
Name:FOURNIER, JESSE HIGGINS (COTA/L)
Entity type:Individual
Prefix:MS
First Name:JESSE
Middle Name:HIGGINS
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:ME
Mailing Address - Zip Code:04346-5107
Mailing Address - Country:US
Mailing Address - Phone:207-446-7510
Mailing Address - Fax:
Practice Address - Street 1:35 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:ME
Practice Address - Zip Code:04346-5107
Practice Address - Country:US
Practice Address - Phone:207-446-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA2207224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant