Provider Demographics
NPI:1275651713
Name:HOUDE, KERALYN ANN (OTRL)
Entity Type:Individual
Prefix:
First Name:KERALYN
Middle Name:ANN
Last Name:HOUDE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:KERALYN
Other - Middle Name:ANN
Other - Last Name:FRASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:14 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-2337
Mailing Address - Country:US
Mailing Address - Phone:508-221-2179
Mailing Address - Fax:
Practice Address - Street 1:146 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532-3902
Practice Address - Country:US
Practice Address - Phone:508-221-2179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist