Individual
CARLA E. PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
80 BOSTON RD, NORTH BILLERICA, MA 01862-1034
(978) 667-2166
Mailing address
467 PROSPECT ST, UNIT 2, METHUEN, MA 01844-7514
(978) 886-2780
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
8622
MA
Other
Enumeration date
02/13/2008
Last updated
02/13/2008
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