Healthcare Provider Details

I. General information

NPI: 1902701170
Provider Name (Legal Business Name): CARLA VADALA POLES OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 EDGEWATER DR STE 300
NORWOOD MA
02062-4642
US

IV. Provider business mailing address

2 ROBBART LN
BOSTON MA
02136-3947
US

V. Phone/Fax

Practice location:
  • Phone: 781-882-8857
  • Fax:
Mailing address:
  • Phone: 617-501-0094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTL31571
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: