=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831621366
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE BEKSHA OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2017
-----------------------------------------------------
Last Update Date | 04/03/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 ELLIS AVE
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02062-3946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-762-6880
-----------------------------------------------------
Fax | 781-278-0762
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 ELLIS AVE
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02062-3946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-762-6880
-----------------------------------------------------
Fax | 781-278-0762
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0019X
-----------------------------------------------------
Taxonomy Name | Physical Rehabilitation Occupational Therapist
-----------------------------------------------------
License Number | 7722
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------