Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | MA |
NPI | 1003098179 |
---|---|
Provider Name | Grace Maria Trudeau |
First Address | Jamaica Plain, MA 02130-2652 |
Second Address | Jamaica Plain, MA 02130-2652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2007 |
Last Update Date | 30/11/2007 |