Provider Demographics
NPI:1871945774
Name:CHASTEEN, WILLIAM RICHARD JR (COTA/L)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RICHARD
Last Name:CHASTEEN
Suffix:JR
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:590 GARDINER RD
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04342-3037
Mailing Address - Country:US
Mailing Address - Phone:912-660-1255
Mailing Address - Fax:
Practice Address - Street 1:984 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3363
Practice Address - Country:US
Practice Address - Phone:207-624-1765
Practice Address - Fax:207-753-3003
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
META3181224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant