Individual
AMANDA MCGILLICUDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
180 MAIN ST, WALPOLE, MA 02081-4020
(774) 203-9071
Mailing address
129 ASH ST, STOUGHTON, MA 02072-3521
(339) 237-8612
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
15342
MA
Other
Enumeration date
12/30/2024
Last updated
12/30/2024
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