MEDICARE: MISS ASHLEE MINAHAN MOT OTRL

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	225X00000X	Occupational Therapist	9101	MA

General Provider Information

NPI Number	:	1467576827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ASHLEE MINAHAN MOT OTRL

Provider Business Mailing Address
First Line	:	27 MICHEL ST
Second Line	:
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-3134
Country	:	US
Telephone Number	:	413-525-6407
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 COOPER ST
Second Line	:
City	:	AGAWAM
State	:	MA
Zip	:	01001-2149
Country	:	US
Telephone Number	:	413-786-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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