Provider Demographics
NPI:1871207852
Name:OSBORNE, ERICA THERESA LYNN
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:THERESA LYNN
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 WEBBS MILLS RD
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071-6320
Mailing Address - Country:US
Mailing Address - Phone:207-655-8672
Mailing Address - Fax:207-655-8664
Practice Address - Street 1:434 WEBBS MILLS RD
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:ME
Practice Address - Zip Code:04071-6320
Practice Address - Country:US
Practice Address - Phone:207-655-8672
Practice Address - Fax:207-655-8664
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency