Healthcare Provider Details

I. General information

NPI: 1932767886
Provider Name (Legal Business Name): LINX AUTISM SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 SHREWSBURY ST LOWR LEVEL
WORCESTER MA
01604-1607
US

IV. Provider business mailing address

490 SHREWSBURY ST LOWR LEVEL
WORCESTER MA
01604-1607
US

V. Phone/Fax

Practice location:
  • Phone: 508-926-8777
  • Fax: 508-463-4132
Mailing address:
  • Phone: 85-926-8777
  • Fax: 85-463-4132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: KIANNA MINOTT
Title or Position: CO-FOUNDER
Credential:
Phone: 508-926-8777