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General NPI Number Information
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NPI Number | 1205407236
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Entity Type | Organization
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Legal Business Name | IMAGO REHAB, INC
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 110 CANAL ST 3RD FLOOR
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City | LOWELL
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State | MA
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Zip | 01852
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Country | US
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Telephone | 617-671-0789
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Fax | 617-250-8243
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Provider Business Mailing Address
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Address Line | 110 CANAL ST 3RD FLOOR
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City | LOWELL
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State | MA
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Zip | 01852-3345
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Country | US
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Telephone |
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Fax | 617-250-8243
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Authorized Official
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Title or Position | CO-FOUNDER, CHIEF CLINICAL OFFICER
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Name | KRISTIN NUCKOLS
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Credential | OTD, MOT, OTR
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Telephone | 617-671-0789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number |
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License Number State |
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