Provider Demographics
NPI:1063392264
Name:HYLAND, ELLA JAYNE (COTA/L)
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:JAYNE
Last Name:HYLAND
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 1:71 N MARRINER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2015
Mailing Address - Country:US
Mailing Address - Phone:207-210-2284
Mailing Address - Fax:
Practice Address - Street 1:170 US ROUTE 1 STE 100
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2152
Practice Address - Country:US
Practice Address - Phone:207-781-0022
Practice Address - Fax:207-781-0025
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA4868224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant