Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 12754 | MA |
N | 225XG0600X | Occupational Therapist - Gerontology | 12754 | MA |
NPI | 1801372818 |
---|---|
Provider Name | Emma Caroline Bibeault |
First Address | Blackstone, MA 01504-1608 |
Second Address | Milford, MA 01757-2900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2018 |
Last Update Date | 12/07/2018 |