Healthcare Provider Details

I. General information

NPI: 1093044943
Provider Name (Legal Business Name): KENNEDY-DONOVAN CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 FOREST ST
ATTLEBORO MA
02703-2407
US

IV. Provider business mailing address

1 COMMERCIAL ST
FOXBORO MA
02035-2530
US

V. Phone/Fax

Practice location:
  • Phone: 508-226-6035
  • Fax: 508-222-1877
Mailing address:
  • Phone: 508-543-2542
  • Fax: 508-543-9488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK BORNSTEIN
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 508-543-2542