Provider Demographics
NPI:1295401446
Name:SPAULDING, MARY CLAIRE (COTA)
Entity Type:Individual
Prefix:
First Name:MARY CLAIRE
Middle Name:
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WOODLAWN AVE APT A4
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03244-4890
Mailing Address - Country:US
Mailing Address - Phone:607-742-4906
Mailing Address - Fax:
Practice Address - Street 1:50 PHEASANT RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-2110
Practice Address - Country:US
Practice Address - Phone:603-924-7267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0861224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant