Provider Demographics
NPI:1104033836
Name:EXCEL ORTHOPEDIC SPECIALISTS
Entity Type:Organization
Organization Name:EXCEL ORTHOPEDIC SPECIALISTS
Other - Org Name:EXCEL ORTHOPEDIC OT
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:FULWIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-782-1320
Mailing Address - Street 1:200 UNICORN PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-3342
Mailing Address - Country:US
Mailing Address - Phone:781-782-1300
Mailing Address - Fax:781-782-1350
Practice Address - Street 1:200 UNICORN PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-3342
Practice Address - Country:US
Practice Address - Phone:781-782-1300
Practice Address - Fax:781-782-1350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCEL ORTHOPEDIC SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-16
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAOG0008OtherBLUE SHIELD GROUP NUMBER
MAOG0008OtherBLUE SHIELD GROUP NUMBER