Healthcare Provider Details

I. General information

NPI: 1811485436
Provider Name (Legal Business Name): HEALTHPRO PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 ACCORD PARK DR
NORWELL MA
02061-1606
US

IV. Provider business mailing address

76 ACCORD PARK DR
NORWELL MA
02061-1606
US

V. Phone/Fax

Practice location:
  • Phone: 781-923-0900
  • Fax:
Mailing address:
  • Phone: 781-923-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERRA RAE SCOTT
Title or Position: SVP OUTPATIENT PEDIATRICS
Credential:
Phone: 303-437-4364