Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 11624 | MA |
NPI | 1043747702 |
---|---|
Provider Name | Ashley Dellinger |
First Address | Medford, MA 02155 |
Second Address | Boston, MA 02111-1552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2017 |
Last Update Date | 12/05/2017 |