Individual
MR. JASON DEMORANVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
62 CENTER ST, FAIRHAVEN, MA 02719-3823
(508) 992-6278
Mailing address
138 MAIN ST APT 7, FAIRHAVEN, MA 02719-3139
(703) 915-9800
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3468
MA
225700000X
Massage Therapist
7603
MA
Other
Enumeration date
12/03/2019
Last updated
12/03/2019
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