Healthcare Provider Details

I. General information

NPI: 1023757119
Provider Name (Legal Business Name): ADRIANA ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 BIGELOW ST
BRIGHTON MA
02135-1610
US

IV. Provider business mailing address

60 BIGELOW ST
BRIGHTON MA
02135-1610
US

V. Phone/Fax

Practice location:
  • Phone: 305-498-8228
  • Fax:
Mailing address:
  • Phone: 305-498-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number12654
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12654
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: