Organization
THE LIVING TREE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLENE E COSTA OTR/L (OWNER/PRESIDENT)
(978) 906-1254
Entity
Organization
Contact information
Practice address
2270 MAIN ST, ATHOL, MA 01331
(978) 906-1254
Mailing address
58 NORTHERN AVE, ATHOL, MA 01331
(978) 906-1254
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
12/14/2023
Last updated
12/14/2023
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