=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831550250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILVER FERN PRACTICE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2016
-----------------------------------------------------
Last Update Date | 11/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75A SCOTLAND BLVD
-----------------------------------------------------
City | BRIDGEWATER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02324-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-697-2000
-----------------------------------------------------
Fax | 508-697-2002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 RICHMOND SQ
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02906-5117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-433-4172
-----------------------------------------------------
Fax | 401-433-0612
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | MICHELLE MARIE MONIZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 401-433-4172
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225400000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------