Provider Demographics
NPI:1437559705
Name:OSTRANDER, JOANNA (MM, MT-BC)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:OSTRANDER
Suffix:
Gender:F
Credentials:MM, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 UPHAM ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3547
Mailing Address - Country:US
Mailing Address - Phone:617-910-0668
Mailing Address - Fax:
Practice Address - Street 1:1290 TREMONT ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02120-3432
Practice Address - Country:US
Practice Address - Phone:617-989-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-24
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA08497225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist