Healthcare Provider Details

I. General information

NPI: 1528187580
Provider Name (Legal Business Name): KERIANN S WILMOT OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERIANN SULLIVAN OTRL

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 HIGHLAND AVE
SALEM MA
01970-2141
US

IV. Provider business mailing address

155 WASHINGTON ST APT 4
HAVERHILL MA
01832-5465
US

V. Phone/Fax

Practice location:
  • Phone: 978-354-2746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number7980
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: