Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2836 | MA |
NPI | 1033384169 |
---|---|
Provider Name | Shannon Cheever-Leclair |
First Address | Peabody, MA 01960-6123 |
Second Address | Woburn, MA 01801-6519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 29/04/2008 |