Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 5828 | MA |
NPI | 1144397126 |
---|---|
Provider Name | Mrs. Stacy P Conneely |
First Address | Brighton, MA 02135-2831 |
Second Address | Newton, MA 02462-1607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |