Healthcare Provider Details

I. General information

NPI: 1770310815
Provider Name (Legal Business Name): KAYLA CERVEIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 VALENTINE RD
PITTSFIELD MA
01201-3042
US

IV. Provider business mailing address

PO BOX 1634
PITTSFIELD MA
01202-1634
US

V. Phone/Fax

Practice location:
  • Phone: 413-445-2300
  • Fax:
Mailing address:
  • Phone: 413-281-0536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15471
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: