Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 10322 | MA |
NPI | 1295169795 |
---|---|
Provider Name | Pooja H Baua |
First Address | Boston, MA 02120-2802 |
Second Address | North Reading, MA 01864-1315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2013 |
Last Update Date | 03/09/2013 |