Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 3368 | MA |
NPI | 1023318862 |
---|---|
Provider Name | Ms. Jill Gridley |
First Address | Beverly, MA 01915-6142 |
Second Address | Beverly, MA 01915-6142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2010 |
Last Update Date | 27/10/2010 |