Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 8400 | MA |
NPI | 1104123603 |
---|---|
Provider Name | Darcy Weller |
First Address | Montague, MA 01351-9576 |
Second Address | Montague, MA 01351-9576 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2011 |
Last Update Date | 17/02/2011 |