Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 6911 | MA |
NPI | 1003271230 |
---|---|
Provider Name | Bridget Dujardin |
First Address | Milton, MA 02186-5626 |
Second Address | Milton, MA 02186-5626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2015 |
Last Update Date | 19/11/2019 |