=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225720444
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILEE ROSE MCCUBREY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2023
-----------------------------------------------------
Last Update Date | 05/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 BARTON ST
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01540-2187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-499-2178
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 HAZEL AVE
-----------------------------------------------------
City | SHREWSBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01545-1211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-523-6080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 78026
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------