Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 2256 | MA |
NPI | 1356822068 |
---|---|
Provider Name | Mr. William Patrick Shea |
First Address | Leominster, MA 01453-3290 |
Second Address | Leominster, MA 01453-3290 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2018 |
Last Update Date | 22/08/2018 |