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NPI Code Detail

MEDICARE: GRACE LITTLEJOHN

MEDICARE: GRACE LITTLEJOHN
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1770309759
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE LITTLEJOHN
Provider Business Mailing Address
First Line : 16 WARE ST APT B
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02138-4034
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1661 WORCESTER RD STE 501
Second Line :
City : FRAMINGHAM
State : MA
Zip : 01701-5405
Country : US
Telephone Number : 508-655-5222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2024
Last Update Date : 11/25/2024

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Directions to “ GRACE LITTLEJOHN ” Practice Location

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