Basic Information
| Provider Information | |||||||||
| NPI: | 1952567190 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODIN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | OT/C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 CUMMINGS CTR | ||||||||
| Address2: | SUITE 3850 | ||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019156142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782320332 | ||||||||
| FaxNumber: | 9782321103 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 CUMMINGS CTR | ||||||||
| Address2: | SUITE 3850 | ||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019156142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782320332 | ||||||||
| FaxNumber: | 9782321103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2008 | ||||||||
| LastUpdateDate: | 08/06/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 144933 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.