Basic Information
| Provider Information | |||||||||
| NPI: | 1285375212 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ST. CYR | ||||||||
| FirstName: | KALEIGH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 522 AMHERST ST STE 22 | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030631019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038800448 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 S MAIN ST | ||||||||
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| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031024405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036260760 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2022 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2862 | 01 | ALLIED HEALTH | OTHER |