Healthcare Provider Details

I. General information

NPI: 1386786770
Provider Name (Legal Business Name): BUZZARDS BAY HAND THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24B SANDWICH RD
WAREHAM MA
02571-1628
US

IV. Provider business mailing address

24B SANDWICH RD
WAREHAM MA
02571-1628
US

V. Phone/Fax

Practice location:
  • Phone: 508-295-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number5789
License Number StateMA

VIII. Authorized Official

Name: BRIAN C KNUTSEN
Title or Position: PRESIDENT
Credential: OTRL, CHT
Phone: 508-295-7400