Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2880 | MA |
NPI | 1023479284 |
---|---|
Provider Name | Ms. Tracy Ann Mcisaac |
First Address | Westfield, MA 01085-4335 |
Second Address | Woburn, MA 01801-7452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2016 |
Last Update Date | 16/03/2016 |