Healthcare Provider Details

I. General information

NPI: 1831352541
Provider Name (Legal Business Name): GERALD JAMES PUCCIORETTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MCGRATH HWY QUINCY REHAB
QUINCY MA
02169
US

IV. Provider business mailing address

11 MCGRATH HWY QUINCY REHAB
QUINCY MA
02169
US

V. Phone/Fax

Practice location:
  • Phone: 617-479-2820
  • Fax: 617-773-8437
Mailing address:
  • Phone: 617-479-2820
  • Fax: 617-773-8437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberAH2142OA
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: