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General NPI Number Information
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NPI Number | 1912786443
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Entity Type | Individual
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Provider Name | SURA MOHAMED HASSOUN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 179 BEAR HILL RD STE 105
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City | WALTHAM
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State | MA
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Zip | 02451-1063
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Country | US
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Telephone | 781-895-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 808 MEMORIAL DR APT 301B
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City | CAMBRIDGE
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State | MA
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Zip | 02139-4647
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Country | US
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Telephone | 617-682-5468
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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 | 14930
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License Number State | MA
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