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General NPI Number Information
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NPI Number | 1669246096
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Entity Type | Individual
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Provider Name | JESSICA PATZWAHL
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Gender | Female
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 1493 CAMBRIDGE ST
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City | CAMBRIDGE
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State | MA
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Zip | 02139-1047
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Country | US
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Telephone | 617-665-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 2 HANCOCK ST APT 419
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City | QUINCY
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State | MA
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Zip | 02171-1763
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Country | US
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Telephone | 518-610-2709
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OTL14328
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License Number State | MA
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