Individual
BRENDA LEE PROVENCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
120 SEMINARY AVE, AUBURNDALE, MA 02466-2650
(617) 663-7023
Mailing address
77 BUNKERHILL PKWY, WEST BOYLSTON, MA 01583-2022
(508) 835-4571
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
8920
MA
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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