Eric Fenn, COTA/L

Key facts

NPI

1255818142

Entity type

Individual (NPI type 1)

Primary specialty

Occupational Therapy Assistant 224Z00000X

License

4340 (MA)

Practice address

61 Old Amherst Rd
Sunderland, MA 01375-7501

Phone

(413) 665-2740

NPI assigned

Jul 24, 2018

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 24, 2018.

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532390400000",
    "number": "1255818142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 TURNPIKE RD",
            "city": "ASHFORD",
            "state": "CT",
            "postal_code": "062782408",
            "telephone_number": "678-938-8369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 OLD AMHERST RD",
            "city": "SUNDERLAND",
            "state": "MA",
            "postal_code": "013757501",
            "telephone_number": "413-665-2740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENN",
        "first_name": "ERIC",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-24",
        "last_updated": "2018-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MA",
            "license": "4340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Sunderland, MA · Occupational Therapy Assistant in Massachusetts