Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2845 | MA |
NPI | 1124171863 |
---|---|
Provider Name | Dr. Tara A O'desky |
First Address | North Andover, MA 01845-4631 |
Second Address | Lynn, MA 01901-1506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 10/08/2011 |