Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 11738 | MA |
NPI | 1295106144 |
---|---|
Provider Name | Manny Marrero |
First Address | Hyannis, MA 02601-3825 |
Second Address | Hyannis, MA 02601-3825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2015 |
Last Update Date | 16/10/2015 |