Active NPI
Lori Broderick, OTR
- Occupational Therapist
- Agawam, MA
National Provider Identifier
1295868909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 20399
- Practice address
- 61 Cooper St
Agawam, MA 01001-2149 - Phone
- (413) 786-8000
- Fax
- (413) 789-2359
- NPI assigned
- Mar 13, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 3104 | MA | |
| Occupational Therapist | 225X00000X | 20399 | FL | Primary |
Addresses
Primary practice location
61 Cooper St
Agawam, MA 01001-2149
Mailing address
510 Woodford Dr
Debary, FL 32713-2123
Phone (413) 297-2921
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7191 | TN | MD | Massage Therapist |
| 20399 | FL | MD | Occupational Therapist |
| 3104 | MA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635897600000",
"number": "1295868909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 WOODFORD DR",
"city": "DEBARY",
"state": "FL",
"postal_code": "327132123",
"telephone_number": "413-297-2921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "61 COOPER ST",
"city": "AGAWAM",
"state": "MA",
"postal_code": "010012149",
"telephone_number": "413-786-8000",
"fax_number": "413-789-2359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODERICK",
"first_name": "LORI",
"name_prefix": "Ms.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-13",
"last_updated": "2021-11-03",
"certification_date": "2021-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MA",
"license": "3104",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "20399",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Agawam, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.