=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871479154
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILVER FERN PRACTICE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2025
-----------------------------------------------------
Last Update Date | 11/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 142 NORTH RD
-----------------------------------------------------
City | SUDBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01776-1142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-231-5944
-----------------------------------------------------
Fax | 401-433-0612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 RICHMOND SQ STE 200
-----------------------------------------------------
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 | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------