Healthcare Provider Details

I. General information

NPI: 1548299043
Provider Name (Legal Business Name): CATHERINE WOOD RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 CURVE ST
MILLIS MA
02054
US

IV. Provider business mailing address

67 UNION ST
NATICK MA
01760-7700
US

V. Phone/Fax

Practice location:
  • Phone: 508-650-7009
  • Fax:
Mailing address:
  • Phone: 508-650-7009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number878
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: