Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 6942 | MA |
NPI | 1225182249 |
---|---|
Provider Name | Mrs. Lisa Bostrom |
First Address | Greenfield, MA 01301-9707 |
Second Address | Greenfield, MA 01301-2025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |