Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 3016 | MA |
NPI | 1043356306 |
---|---|
Provider Name | Ms. Deborah Rose Bauch |
First Address | Boxborough, MA 01719-2012 |
Second Address | Acton, MA 01720-3301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |