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General NPI Number Information
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NPI Number | 1962060640
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Entity Type | Individual
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Provider Name | DANIELLE JOYCE LYDON MSOT
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Gender | Female
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 1115 W CHESTNUT ST
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City | BROCKTON
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State | MA
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Zip | 02301-7501
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Country | US
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Telephone | 508-521-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 151 MINOT ST
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City | BOSTON
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State | MA
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Zip | 02122-2001
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Country | US
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Telephone | 617-905-0903
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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 | 12470
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License Number State | MA
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