Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 11875 | MA |
NPI | 1164950994 |
---|---|
Provider Name | John Charles Chambers |
First Address | Lynn, MA 01905-1831 |
Second Address | Medford, MA 02155-1300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2017 |
Last Update Date | 24/05/2017 |