Healthcare Provider Details

I. General information

NPI: 1629646278
Provider Name (Legal Business Name): KELSIE LYNN RAINONE DS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 VANDERBILT AVE
NORWOOD MA
02062-5011
US

IV. Provider business mailing address

7 WINTERGREEN LN
PLAINVILLE MA
02762-1999
US

V. Phone/Fax

Practice location:
  • Phone: 781-551-0405
  • Fax:
Mailing address:
  • Phone: 508-838-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: