Provider Demographics
NPI:1346364148
Name:KERSHAW, DOLORES IVETTE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:IVETTE
Last Name:KERSHAW
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4218
Mailing Address - Country:US
Mailing Address - Phone:781-289-4306
Mailing Address - Fax:
Practice Address - Street 1:999 BROADWAY STE 304
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-4510
Practice Address - Country:US
Practice Address - Phone:781-289-4306
Practice Address - Fax:781-558-9565
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8818225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist