Individual
MR. JAMES M THERIAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
279 VERMONT AVE, SOMERSET, MA 02726
(774) 888-8233
Mailing address
279 VERMONT AVE, SOMERSET, MA 02726-3830
(774) 888-8233
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3025
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3025
ALLIED HEALTH PROFESSIONALS
MA
Enumeration date
10/23/2017
Last updated
10/23/2017
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