Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 9289 | MA |
NPI | 1245749977 |
---|---|
Provider Name | Cheryl Ann Theroux |
First Address | Springfield, MA 01107-1140 |
Second Address | Springfield, MA 01107-1140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2017 |
Last Update Date | 26/09/2017 |