Healthcare Provider Details

I. General information

NPI: 1801386560
Provider Name (Legal Business Name): MAURA KELLIHER MCKNIGHT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 VANDERBILT AVE
NORWOOD MA
02062-5011
US

IV. Provider business mailing address

149 BARNEY ST
RUMFORD RI
02916-1113
US

V. Phone/Fax

Practice location:
  • Phone: 781-551-0405
  • Fax:
Mailing address:
  • Phone: 401-533-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12697
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: