Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1788 | MA |
NPI | 1023133089 |
---|---|
Provider Name | Andrea Marie Lassor |
First Address | Dalton, MA 01226-2070 |
Second Address | Pittsfield, MA 01201-3042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |