Healthcare Provider Details

I. General information

NPI: 1073173688
Provider Name (Legal Business Name): PARIS TRENT MASSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1194 NAAMANS CREEK RD
GARNET VALLEY PA
19060-1615
US

IV. Provider business mailing address

8723 W CHESTER PIKE APT F9
UPPER DARBY PA
19082-1117
US

V. Phone/Fax

Practice location:
  • Phone: 610-558-7840
  • Fax:
Mailing address:
  • Phone: 215-253-0186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberTOP009272
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: