Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 3449 | MA |
NPI | 1003415530 |
---|---|
Provider Name | Melissa Koteff |
First Address | New Bedford, MA 02740-2422 |
Second Address | Fairhaven, MA 02719-3822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2020 |
Last Update Date | 26/10/2020 |