Basic Information
| Provider Information | |||||||||
| NPI: | 1184079634 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BAMSI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023013052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085865977 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023013052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085865977 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2016 | ||||||||
| LastUpdateDate: | 05/03/2016 | ||||||||
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| AuthorizedOfficialLastName: | MUDD | ||||||||
| AuthorizedOfficialFirstName: | GENEVIEVE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5085865977 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OTR/L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | 11862 | MA | Y | Agencies | Early Intervention Provider Agency |
No ID Information.