Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 10090 | MA |
NPI | 1396377388 |
---|---|
Provider Name | Matthew Thomas |
First Address | Carver, MA 02330-1066 |
Second Address | Braintree, MA 02184-2706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2020 |
Last Update Date | 07/02/2020 |