Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 12309 | MA |
NPI | 1003396748 |
---|---|
Provider Name | Elizabeth O'hare |
First Address | Braintree, MA 02184-6565 |
Second Address | Walpole, MA 02081-4037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2018 |
Last Update Date | 21/08/2018 |