Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 5036 | MA |
NPI | 1003093840 |
---|---|
Provider Name | Mrs. Stacey Bettcher Wilson |
First Address | West Newbury, MA 01985-0956 |
Second Address | West Newbury, MA 01985-1420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2008 |
Last Update Date | 23/01/2008 |