Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
Y | 2251P0200X | Physical Therapist - Pediatrics | 20908 | MA |
NPI | 1124528823 |
---|---|
Provider Name | Chelsey Ouellette |
First Address | Woburn, MA 01801-1721 |
Second Address | Woburn, MA 01801-1721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2018 |
Last Update Date | 19/02/2018 |