Healthcare Provider Details

I. General information

NPI: 1760508261
Provider Name (Legal Business Name): JULIE J D'AVANZO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 COOPER ST
AGAWAM MA
01001-2149
US

IV. Provider business mailing address

7 JOAN ST
WILBRAHAM MA
01095-2036
US

V. Phone/Fax

Practice location:
  • Phone: 413-786-8000
  • Fax:
Mailing address:
  • Phone: 413-596-2617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6016
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: