Healthcare Provider Details

I. General information

NPI: 1275065203
Provider Name (Legal Business Name): ELIAZABETH CONDON B.S., OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N MEADOWS RD SPEECH-LANGUAGE & HEARING ASSOCIATES
MEDFIELD MA
02052-2317
US

IV. Provider business mailing address

5 N MEADOWS RD SPEECH-LANGUAGE & HEARING ASSOCIATES
MEDFIELD MA
02052-2317
US

V. Phone/Fax

Practice location:
  • Phone: 508-359-4532
  • Fax: 508-359-0198
Mailing address:
  • Phone: 508-359-4532
  • Fax: 508-359-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1597
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: