Individual
REBECCA HENAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTAL
Contact information
Practice address
136A ARCH ST, KEENE, NH 03431-2186
(603) 357-3902
Mailing address
122 ROUTE 9, SULLIVAN, NH 03445-4226
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0612
NH
Other
Enumeration date
08/27/2014
Last updated
08/27/2014
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