Healthcare Provider Details

I. General information

NPI: 1659567790
Provider Name (Legal Business Name): GWENDOLYN JANICE SHEEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2007
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 HALL ST STE H
CONCORD NH
03301-3442
US

IV. Provider business mailing address

124 HALL ST STE H
CONCORD NH
03301-3442
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-9160
  • Fax:
Mailing address:
  • Phone: 603-228-9160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1353
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: