Angela K Deterra, COTA/L

Individual provider Active NPI Occupational Therapy Assistant · Acushnet, MA

NPI 1306127188 · NPPES record last updated Sep 7, 2011

Key facts

NPI
1306127188
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
OTA00184-G (RI)
Practice address
1 Bow Dr
Acushnet, MA 02743-1731
Phone
(508) 951-1935
NPI assigned
Sep 7, 2011
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
OTA00184-GRIMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X OTA00184-G RI Yes

Addresses

Primary practice location

1 Bow Dr
Acushnet, MA 02743-1731

Mailing address

1 Bow Dr
Acushnet, MA 02743-1731
Phone (508) 951-1935

Other providers in Acushnet, MA

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

Sources for this page

Verify at the official NPI Registry.