Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 12429 | MA |
NPI | 1215455456 |
---|---|
Provider Name | Tatum Fahs |
First Address | Somerville, MA 02145-2922 |
Second Address | Peabody, MA 01960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2017 |
Last Update Date | 08/09/2017 |