Healthcare Provider Details

I. General information

NPI: 1528601226
Provider Name (Legal Business Name): KAROLINE O'HARA MORIARTY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 S WESTFIELD ST
FEEDING HILLS MA
01030-2702
US

IV. Provider business mailing address

14 S WESTFIELD ST
FEEDING HILLS MA
01030-2702
US

V. Phone/Fax

Practice location:
  • Phone: 413-786-2957
  • Fax: 413-786-2977
Mailing address:
  • Phone: 413-786-2957
  • Fax: 413-786-2977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4917-NU-NU
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: