Healthcare Provider Details

I. General information

NPI: 1861204802
Provider Name (Legal Business Name): MEGAN ANNE VACCARO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PLYMOUTH AVE
QUINCY MA
02169-1116
US

IV. Provider business mailing address

150 PLYMOUTH AVE
QUINCY MA
02169-1116
US

V. Phone/Fax

Practice location:
  • Phone: 617-799-2228
  • Fax:
Mailing address:
  • Phone: 617-799-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6915
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: