MEDICARE: HEALTHPRO PEDIATRICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1083084883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHPRO PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	76 ACCORD PARK DR
Second Line	:
City	:	NORWELL
State	:	MA
Zip	:	02061-1606
Country	:	US
Telephone Number	:	781-923-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 ACCORD PARK DR
Second Line	:
City	:	NORWELL
State	:	MA
Zip	:	02061-1606
Country	:	US
Telephone Number	:	781-923-0900
Fax Number	:

Authorized Official
Title or Position	:	SVP OUTPATIENT PEDIATRICS
Name	:	TERRA RAE SCOTT
Credential	:	MSPT
Telephone Number	:	303-437-4364

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	10/28/2021

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