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NPI Code Detail

MEDICARE: MICHAEL ENNIS OTR

MEDICARE: MICHAEL ENNIS OTR
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
1225X00000XOccupational Therapist5229MA

General Provider Information

NPI Number : 1285844936
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL ENNIS OTR
Provider Business Mailing Address
First Line : 211 CENTRE ST
Second Line :
City : HOLBROOK
State : MA
Zip : 02343-1012
Country : US
Telephone Number : 781-961-3994
Fax Number :
Provider Business Practice Location Address
First Line : 164 PARKINGWAY ST
Second Line :
City : QUINCY
State : MA
Zip : 02169-5020
Country : US
Telephone Number : 617-773-4222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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