Basic Information
| Provider Information | |||||||||
| NPI: | 1649668815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VERVILLE | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 463 SWANSEA MALL DRIVE | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083241060 | ||||||||
| FaxNumber: | 5085805162 | ||||||||
| Practice Location | |||||||||
| Address1: | 463 SWANSEA MALL DR | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027774119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083241060 | ||||||||
| FaxNumber: | 5085805162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2014 | ||||||||
| LastUpdateDate: | 12/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.