Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 11298 | MA |
NPI | 1659744522 |
---|---|
Provider Name | Sarah Johnson |
First Address | Waltham, MA 02451-1063 |
Second Address | Waltham, MA 02451-1063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2015 |
Last Update Date | 02/11/2015 |