Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 12316 | MA |
NPI | 1366964694 |
---|---|
Provider Name | Greta Devolder |
First Address | Boston, MA 02116-1666 |
Second Address | Arlington, MA 02476-5828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2017 |
Last Update Date | 07/07/2017 |