Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 3125 | MA |
NPI | 1033407887 |
---|---|
Provider Name | Kelly Giaquinto |
First Address | Medford, MA 02155-2349 |
Second Address | Medford, MA 02155-2349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2011 |
Last Update Date | 14/07/2011 |