Healthcare Provider Details

I. General information

NPI: 1275832982
Provider Name (Legal Business Name): BUZZARDS BAY HAND THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 MASSACHUSETTS AVE SUITE 202
LEXINGTON MA
02420-4000
US

IV. Provider business mailing address

119 WAREHAM RD UNIT 107
MARION MA
02738-1178
US

V. Phone/Fax

Practice location:
  • Phone: 508-748-3933
  • Fax:
Mailing address:
  • Phone: 508-748-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5789
License Number StateMA

VIII. Authorized Official

Name: BRIAN KNUTSEN
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L, CHT
Phone: 508-748-3933