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General NPI Number Information
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NPI Number | 1710375449
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Entity Type | Individual
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Provider Name | MS. LEAH MICU
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Gender | Female
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 01/05/2015
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Provider Practice Location Address
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Address Line | 484 MAIN ST
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City | WORCESTER
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State | MA
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Zip | 01608-1893
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Country | US
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Telephone | 800-244-2756
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Fax | 508-831-9768
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Provider Business Mailing Address
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Address Line | 559 E 4TH ST #3
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City | BOSTON
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State | MA
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Zip | 02127-3023
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Country | US
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Telephone | 781-864-0632
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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 | 10636
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License Number State | MA
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