Healthcare Provider Details

I. General information

NPI: 1386711851
Provider Name (Legal Business Name): LINDA CORREIA OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

25 HARBORVIEW AVE APT 3
BRISTOL RI
02809-1708
US

V. Phone/Fax

Practice location:
  • Phone: 401-432-6800
  • Fax: 401-444-8270
Mailing address:
  • Phone: 401-432-6800
  • Fax: 401-444-8270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT01025
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: