=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366562977
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAURA DESMARAIS OTRL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 PARKMAN ST
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02114-3117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-726-8537
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 OPOSSUM DR
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03036-8114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-887-6579
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 4312
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------