Individual
BROOKE EVANGELINE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
40 PARKHURST RD, CHELMSFORD, MA 01824-1513
(978) 256-3151
Mailing address
429 CROSS ST, BOYLSTON, MA 01505-1420
(774) 261-3673
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3694
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
0
—
Enumeration date
01/29/2018
Last updated
01/29/2018
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