Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 8568 | MA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 8568 | MA |
NPI | 1346698412 |
---|---|
Provider Name | Mrs. Shobha Sandeep Menon |
First Address | Newton, MA 02460-1914 |
Second Address | Chestnut Hill, MA 02467-2160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2016 |
Last Update Date | 31/05/2016 |