Healthcare Provider Details

I. General information

NPI: 1770009003
Provider Name (Legal Business Name): MR. KEVIN MICHAEL CAREY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 PROMENADE ST
PROVIDENCE RI
02908-5794
US

IV. Provider business mailing address

285 PROMENADE ST
PROVIDENCE RI
02908-5794
US

V. Phone/Fax

Practice location:
  • Phone: 401-777-7000
  • Fax: 401-459-4010
Mailing address:
  • Phone: 401-777-7000
  • Fax: 401-459-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT01777
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: