Healthcare Provider Details

I. General information

NPI: 1871884148
Provider Name (Legal Business Name): THOM MARLBORO AREA EARLY INTERVENTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 BOSTON POST RD E STE 150
MARLBOROUGH MA
01752-3527
US

IV. Provider business mailing address

221 BOSTON POST RD E STE 150
MARLBOROUGH MA
01752-3527
US

V. Phone/Fax

Practice location:
  • Phone: 508-624-0304
  • Fax:
Mailing address:
  • Phone: 508-624-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: NANCY PHILLIPS
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 508-624-0304