Healthcare Provider Details

I. General information

NPI: 1053843920
Provider Name (Legal Business Name): CHRISTOPHER GIANFRIDDO OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369 GRAFTON ST
WORCESTER MA
01604-2737
US

IV. Provider business mailing address

12 TOWN FARM ROAD PO BOX 174
NORTH BROOKFIELD MA
01535
US

V. Phone/Fax

Practice location:
  • Phone: 508-373-7400
  • Fax:
Mailing address:
  • Phone: 508-735-3148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8576
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: