Healthcare Provider Details

I. General information

NPI: 1255514774
Provider Name (Legal Business Name): SANDRA MARIE DEYO-BOYLSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 CASTLE ST
GREAT BARRINGTON MA
01230-1502
US

IV. Provider business mailing address

54 CASTLE ST
GREAT BARRINGTON MA
01230-1502
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-9311
  • Fax: 413-528-2863
Mailing address:
  • Phone: 413-528-9311
  • Fax: 413-528-2863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7721
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: