Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 11163 | MA |
NPI | 1003486283 |
---|---|
Provider Name | Brynn Speroni |
First Address | Cherry Hill, NJ 08003-1000 |
Second Address | Waltham, MA 02451-1255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2021 |
Last Update Date | 29/06/2021 |