Active NPI
Mary Boudreau, OTA
- Occupational Therapy Assistant
- Holyoke, MA
National Provider Identifier
1912371337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 2378
- Practice address
- 279 Cabot St
Holyoke, MA 01040-3139 - Phone
- (413) 536-3435
- Fax
- (413) 536-8259
- NPI assigned
- Nov 23, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 2378 | MA | Primary |
Addresses
Primary practice location
279 Cabot St
Holyoke, MA 01040-3139
Mailing address
279 Cabot St
Holyoke, MA 01040-3139
Phone (413) 536-3435
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2378 | Other | MA | STATE MASS OTA LICENSE |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2378 | MA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1448236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448236800000",
"number": "1912371337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "279 CABOT ST",
"city": "HOLYOKE",
"state": "MA",
"postal_code": "010403139",
"telephone_number": "413-536-3435",
"fax_number": "413-536-8259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "279 CABOT ST",
"city": "HOLYOKE",
"state": "MA",
"postal_code": "010403139",
"telephone_number": "413-536-3435",
"fax_number": "413-536-8259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDREAU",
"first_name": "MARY",
"name_prefix": "Mrs.",
"credential": "OTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-11-23",
"last_updated": "2015-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MA",
"license": "2378",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE MASS OTA LICENSE",
"identifier": "2378",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Holyoke, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.