Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1957 | MA |
NPI | 1023672086 |
---|---|
Provider Name | Mrs. Diane Marie Gallant |
First Address | Ipswich, MA 01938-1204 |
Second Address | Andover, MA 01810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2019 |
Last Update Date | 25/04/2019 |