Provider Demographics
NPI:1669753547
Name:MY PEDIATRIC OT SERVICES
Entity type:Organization
Organization Name:MY PEDIATRIC OT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:508-208-8438
Mailing Address - Street 1:45 DONEGAL WAY
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-3427
Mailing Address - Country:US
Mailing Address - Phone:508-208-8438
Mailing Address - Fax:508-337-4590
Practice Address - Street 1:45 DONEGAL WAY
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-3427
Practice Address - Country:US
Practice Address - Phone:508-208-8438
Practice Address - Fax:508-337-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2170261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center