Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 6302 | MA |
NPI | 1053615195 |
---|---|
Provider Name | Benjamin Michael Travers |
First Address | Abington, MA 02351-4015 |
Second Address | Braintree, MA 02184-4301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2011 |
Last Update Date | 04/01/2011 |