Healthcare Provider Details

I. General information

NPI: 1679452536
Provider Name (Legal Business Name): TESS SOMERVILLE MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 UNION ST
NATICK MA
01760-6056
US

IV. Provider business mailing address

230 WILGUS DR
RUSSELLS POINT OH
43348-9559
US

V. Phone/Fax

Practice location:
  • Phone: 508-433-4400
  • Fax:
Mailing address:
  • Phone: 614-354-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: