Provider Demographics
NPI:1962883959
Name:LANGIS, JUSTIN DENNIS
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DENNIS
Last Name:LANGIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JUSTIN
Other - Middle Name:DENNIS
Other - Last Name:LANGIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:30 BOUTELLE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 MINOT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4332
Practice Address - Country:US
Practice Address - Phone:207-784-3573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA3026224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant