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NPI Code Detail

MEDICARE: KENNETH D PAVAO OTA

MEDICARE: KENNETH D PAVAO OTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant3001MA
2224Z00000XOccupational Therapy Assistant00376RI

General Provider Information

NPI Number : 1063538361
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH D PAVAO OTA
Provider Business Mailing Address
First Line : 17 ADIRONDACK LN
Second Line :
City : WESTPORT
State : MA
Zip : 02790-3311
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 863 HATHAWAY RD
Second Line :
City : NEW BEDFORD
State : MA
Zip : 02740-1916
Country : US
Telephone Number : 508-996-6763
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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