Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 12432 | MA |
NPI | 1003424524 |
---|---|
Provider Name | Emily Gammell |
First Address | Northampton, MA 01060-2364 |
Second Address | Northampton, MA 01060-2364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2020 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12432 | STATE LICENSURE (01) | MA |