MEDICARE: ABIGAIL STARK OTR/L

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	OTL15279	MA

General Provider Information

NPI Number	:	1851116248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL STARK OTR/L

Provider Business Mailing Address
First Line	:	703 GRANITE ST STE 3
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-5350
Country	:	US
Telephone Number	:	781-807-6138
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 FAUNCE CORNER RD STE C
Second Line	:
City	:	NORTH DARTMOUTH
State	:	MA
Zip	:	02747-1258
Country	:	US
Telephone Number	:	774-425-7906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	11/20/2024

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Directions to “ ABIGAIL STARK OTR/L” Practice Location

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