Provider Demographics
NPI:1275556490
Name:SOUTH EAST CENTER FOR OT INC
Entity Type:Organization
Organization Name:SOUTH EAST CENTER FOR OT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAUCH-CADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:508-999-4345
Mailing Address - Street 1:52 BRIGHAM STREET
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740
Mailing Address - Country:US
Mailing Address - Phone:508-999-4345
Mailing Address - Fax:508-717-6258
Practice Address - Street 1:52 BRIGHAM STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-999-4345
Practice Address - Fax:508-717-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5579225X00000X
MA710225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2485439OtherUNITED HEALTH
MA000000030566OtherBMC
MA605702OtherTUFTS
MAAA22405OtherHARVARD PILGRIM