Provider Demographics
NPI:1114301264
Name:NANTUCKET THERAPY LLC
Entity Type:Organization
Organization Name:NANTUCKET THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYES
Authorized Official - Suffix:
Authorized Official - Credentials:MA/CCC-SLP
Authorized Official - Phone:508-648-8348
Mailing Address - Street 1:125 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-4028
Mailing Address - Country:US
Mailing Address - Phone:508-221-0228
Mailing Address - Fax:508-796-6262
Practice Address - Street 1:125 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-4028
Practice Address - Country:US
Practice Address - Phone:508-221-0228
Practice Address - Fax:508-796-6262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NANTUCKET THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10012225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty