Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | AH3673OT | MA |
NPI | 1003175548 |
---|---|
Provider Name | Kristin Macdonald |
First Address | Wareham, MA 02571 |
Second Address | Wareham, MA 02571-5013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2012 |
Last Update Date | 03/05/2012 |