Provider Demographics
NPI:1073817623
Name:INTEGRATED MIND & BODY, LLC
Entity Type:Organization
Organization Name:INTEGRATED MIND & BODY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:781-622-0515
Mailing Address - Street 1:304 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5116
Mailing Address - Country:US
Mailing Address - Phone:781-622-0515
Mailing Address - Fax:857-277-1921
Practice Address - Street 1:26 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5306
Practice Address - Country:US
Practice Address - Phone:781-622-0515
Practice Address - Fax:857-277-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA416225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0351059Medicaid
MAOG0017Medicaid