Healthcare Provider Details

I. General information

NPI: 1548387921
Provider Name (Legal Business Name): MR. DAVID ANDREW WILLWERTH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 W BOYLSTON ST 799 W BOYLSTON ST
WORCESTER MA
01606-3071
US

IV. Provider business mailing address

799 W BOYLSTON ST MAB COMMUNITY SERVICES
WORCESTER MA
01606-3071
US

V. Phone/Fax

Practice location:
  • Phone: 508-854-0732
  • Fax: 508-854-0733
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number11223
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: