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General NPI Number Information
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NPI Number | 1124489562
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Entity Type | Organization
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Legal Business Name | MICHAEL DEFOSSE
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Dates
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Enumeration Date | 03/13/2016
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Last Update Date | 03/13/2016
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Provider Practice Location Address
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Address Line | 1011 ARLINGTON BLVD APT 1031 SUITE 1031
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City | ARLINGTON
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State | VA
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Zip | 22209-2210
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Country | US
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Telephone | 617-699-3527
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Fax |
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Provider Business Mailing Address
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Address Line | 1011 ARLINGTON BLVD APT 1031 SUITE 1031
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City | ARLINGTON
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State | VA
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Zip | 22209-2210
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Country | US
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Telephone | 617-699-3527
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MR. MICHAEL S DEFOSSE
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Credential |
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Telephone | 617-699-3527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | 8852
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 8852
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License Number State | MA
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