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General NPI Number Information
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NPI Number | 1275832982
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Entity Type | Organization
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Legal Business Name | BUZZARDS BAY HAND THERAPY, LLC
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 363 MASSACHUSETTS AVE SUITE 202
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City | LEXINGTON
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State | MA
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Zip | 02420-4000
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Country | US
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Telephone | 508-748-3933
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Fax |
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Provider Business Mailing Address
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Address Line | 119 WAREHAM RD UNIT 107
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City | MARION
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State | MA
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Zip | 02738-1178
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Country | US
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Telephone | 508-748-3933
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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 | BRIAN KNUTSEN
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Credential | OTR/L, CHT
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Telephone | 508-748-3933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5789
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License Number State | MA
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