Healthcare Provider Details

I. General information

NPI: 1154817609
Provider Name (Legal Business Name): PATRICIA L MEAD-WHEELOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 SOUTH ST
THREE RIVERS MA
01080-1220
US

IV. Provider business mailing address

54 SOUTH ST
THREE RIVERS MA
01080-1220
US

V. Phone/Fax

Practice location:
  • Phone: 413-530-5926
  • Fax:
Mailing address:
  • Phone: 413-530-5926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: