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General NPI Number Information
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NPI Number | 1750240842
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Entity Type | Individual
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Provider Name | CARISSA SOPHIA LOESCH
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Gender |
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/15/2026
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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 | 617-389-6270
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Fax |
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Provider Business Mailing Address
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Address Line | 98 CHELSEA ST
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City | EVERETT
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State | MA
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Zip | 02149-3531
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Country | US
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Telephone | 857-310-2602
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 538702
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License Number State | MA
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