MEDICARE: GAMBARU CORPORATION

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
1	225X00000X	Occupational Therapist	8818	MA
2	225XP0019X	Physical Rehabilitation Occupational Therapist	8818	MA
3	225XF0002X	Feeding, Eating & Swallowing Occupational Therapist	8818	MA
4	225100000X	Physical Therapist
5	2251P0200X	Pediatric Physical Therapist
6	2251S0007X	Sports Physical Therapist
7	2251X0800X	Orthopedic Physical Therapist
8	235Z00000X	Speech-Language Pathologist
9	2355S0801X	Speech-Language Assistant
10	225XP0200X	Pediatric Occupational Therapist	8818	MA

General Provider Information

NPI Number	:	1194974683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAMBARU CORPORATION

Provider Business Mailing Address
First Line	:	999 BROADWAY
Second Line	:	SUITE 100
City	:	SAUGUS
State	:	MA
Zip	:	01906-4521
Country	:	US
Telephone Number	:	781-558-9565
Fax Number	:	781-558-9567

Provider Business Practice Location Address
First Line	:	999 BROADWAY
Second Line	:	SUITE 100
City	:	SAUGUS
State	:	MA
Zip	:	01906-4521
Country	:	US
Telephone Number	:	781-558-9565
Fax Number	:	781-558-9567

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. DOLORES IVETTE KERSHAW
Credential	:	MS,OTR/L
Telephone Number	:	617-899-8380

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	12/08/2010

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Directions to “GAMBARU CORPORATION ” Practice Location

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