Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XG0600X | Occupational Therapist - Gerontology | ||
N | 225XL0004X | Low Vision |
NPI | 1255926770 |
---|---|
Provider Name | Mr. Gerry Auguste |
First Address | Woburn, MA 01801-2114 |
Second Address | Woburn, MA 01801-2114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2021 |
Last Update Date | 19/04/2021 |