Provider Demographics
NPI:1225588494
Name:AYIWA-MENSAH, AFIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:AFIA
Middle Name:
Last Name:AYIWA-MENSAH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 SAVOY AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2008
Mailing Address - Country:US
Mailing Address - Phone:413-777-1468
Mailing Address - Fax:
Practice Address - Street 1:58 SAVOY AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2008
Practice Address - Country:US
Practice Address - Phone:413-777-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12112320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12112OtherALLIED HEALTH PROFESSIONALS