Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 181 | MA |
NPI | 1003264128 |
---|---|
Provider Name | Margaret Gibbons |
First Address | Newton Center, MA 02459-2416 |
Second Address | Weston, MA 02493-2431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2016 |
Last Update Date | 31/05/2016 |