Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 12700 | MA |
NPI | 1730700642 |
---|---|
Provider Name | Elizabeth Mulry |
First Address | Holbrook, MA 02343-1799 |
Second Address | West Bridgewater, MA 02379-1517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2020 |
Last Update Date | 01/05/2020 |