Provider Demographics
NPI:1982427431
Name:WHITTEN, WILLOW OLIVIA (MS OTR/L)
Entity type:Individual
Prefix:MS
First Name:WILLOW
Middle Name:OLIVIA
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5511
Mailing Address - Country:US
Mailing Address - Phone:207-551-7449
Mailing Address - Fax:
Practice Address - Street 1:61 PEARL ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5511
Practice Address - Country:US
Practice Address - Phone:207-551-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT4719225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist