Healthcare Provider Details

I. General information

NPI: 1184655565
Provider Name (Legal Business Name): EMILY B LENNON OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EDDY STREET
PROVIDENCE RI
02905
US

IV. Provider business mailing address

1000 EDDY STREET
PROVIDENCE RI
02905
US

V. Phone/Fax

Practice location:
  • Phone: 401-533-9100
  • Fax:
Mailing address:
  • Phone: 401-533-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT00186
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: