Individual
MR. MARK EDGAR GUILLEMETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
626 EASTVIEW AVE, SOMERSET, MA 02726-3809
(508) 335-2495
Mailing address
626 EASTVIEW AVE, SOMERSET, MA 02726-3809
(508) 335-2495
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2991
MA
224Z00000X
Occupational Therapy Assistant
OTA00366
RI
Other
Enumeration date
02/08/2013
Last updated
02/08/2013
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