Healthcare Provider Details

I. General information

NPI: 1114301264
Provider Name (Legal Business Name): NANTUCKET THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 ORANGE ST
NANTUCKET MA
02554-4028
US

IV. Provider business mailing address

125 ORANGE ST
NANTUCKET MA
02554-4028
US

V. Phone/Fax

Practice location:
  • Phone: 508-221-0228
  • Fax: 508-796-6262
Mailing address:
  • Phone: 508-221-0228
  • Fax: 508-796-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10012
License Number StateMA

VIII. Authorized Official

Name: CARYNNE KEYES
Title or Position: OWNER/DIRECTOR
Credential: MA/CCC-SLP
Phone: 508-648-8348