Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 10396 | MA |
NPI | 1003214958 |
---|---|
Provider Name | Shawna O'brien |
First Address | Braintree, MA 02184-4840 |
Second Address | Braintree, MA 02184-4840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2014 |
Last Update Date | 09/12/2014 |