Provider Demographics
NPI:1073991584
Name:COMEAU, ELLEN (OT)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:COMEAU
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 OFF HARRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3926
Mailing Address - Country:US
Mailing Address - Phone:978-369-3053
Mailing Address - Fax:
Practice Address - Street 1:24 OFF HARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3926
Practice Address - Country:US
Practice Address - Phone:978-369-3053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3878225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist