Healthcare Provider Details

I. General information

NPI: 1215052626
Provider Name (Legal Business Name): PAUL FRANCIS BARSALOU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 COOPER ST
AGAWAM MA
01001-2149
US

IV. Provider business mailing address

112 ALBEMARLE RD
LONGMEADOW MA
01106-2604
US

V. Phone/Fax

Practice location:
  • Phone: 413-786-8000
  • Fax:
Mailing address:
  • Phone: 413-567-5823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6705
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: