Healthcare Provider Details

I. General information

NPI: 1376768812
Provider Name (Legal Business Name): QUINN MICHELE O'HARA PHYSICAL THERAPY ASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: QUINN MICHELE BROWN

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 COOPER ST
AGAWAM MA
01001-2149
US

IV. Provider business mailing address

61 MANSFIELD ST
SPRINGFIELD MA
01108-2208
US

V. Phone/Fax

Practice location:
  • Phone: 413-786-8000
  • Fax:
Mailing address:
  • Phone: 860-668-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number711
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: