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NPI Code Detail

MEDICARE: CARLA E. PROVOST OT

MEDICARE:   CARLA E. PROVOST  OT
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 Therapist8622MA

General Provider Information

NPI Number : 1699943571
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLA E. PROVOST OT
Provider Business Mailing Address
First Line : 467 PROSPECT ST
Second Line : UNIT 2
City : METHUEN
State : MA
Zip : 01844-7514
Country : US
Telephone Number : 978-886-2780
Fax Number :
Provider Business Practice Location Address
First Line : 80 BOSTON RD
Second Line :
City : NORTH BILLERICA
State : MA
Zip : 01862-1034
Country : US
Telephone Number : 978-667-2166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2008
Last Update Date : 02/13/2008

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Directions to “ CARLA E. PROVOST OT” Practice Location

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