Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 3830 | MA |
N | 225XG0600X | Occupational Therapist - Gerontology | 3830 | MA |
NPI | 1356875785 |
---|---|
Provider Name | Chris Digiammarino |
First Address | Peabody, MA 01960-5975 |
Second Address | Kittery Point, ME 03905-5104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2017 |
Last Update Date | 12/04/2017 |