Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 12236 | MA |
NPI | 1629615687 |
---|---|
Provider Name | Kimberly A Yablonsky |
First Address | Hanscom Afb, MA 01731-2633 |
Second Address | Waltham, MA 02453-6058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2019 |
Last Update Date | 09/12/2019 |