Healthcare Provider Details

I. General information

NPI: 1144709031
Provider Name (Legal Business Name): THOMAS MARSH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E MAIN ST STE 200
MILFORD MA
01757-2806
US

IV. Provider business mailing address

321 FORTUNE BLVD
MILFORD MA
01757-1750
US

V. Phone/Fax

Practice location:
  • Phone: 508-478-0207
  • Fax: 508-634-6984
Mailing address:
  • Phone: 508-478-0207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4136
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: