Healthcare Provider Details

I. General information

NPI: 1023299872
Provider Name (Legal Business Name): MISS DIANE JOAN CAULEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10J GILL ST
WOBURN MA
01801-1721
US

IV. Provider business mailing address

10J GILL ST
WOBURN MA
01801-1721
US

V. Phone/Fax

Practice location:
  • Phone: 781-932-2888
  • Fax: 781-932-9809
Mailing address:
  • Phone: 781-932-2888
  • Fax: 781-932-9809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: