Healthcare Provider Details

I. General information

NPI: 1093953846
Provider Name (Legal Business Name): ANGELA MARY PUCINO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA MARY MURPHY OTR/L

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BIRCHWOOD DR
HUNTINGTON MA
01050-9623
US

IV. Provider business mailing address

10 BIRCHWOOD DR
HUNTINGTON MA
01050-9623
US

V. Phone/Fax

Practice location:
  • Phone: 413-297-4057
  • Fax: 413-207-3042
Mailing address:
  • Phone: 413-297-4057
  • Fax: 413-207-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5445
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: