Provider Demographics
NPI:1174791040
Name:CUNNIFF, MARY (MSOTR/L)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:CUNNIFF
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CUMMINGS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-2906
Mailing Address - Country:US
Mailing Address - Phone:781-864-4341
Mailing Address - Fax:
Practice Address - Street 1:14 CUMMINGS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2906
Practice Address - Country:US
Practice Address - Phone:781-864-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3323225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist