Provider Demographics
NPI:1376030155
Name:WALD, DENA MICHELLE (OT)
Entity Type:Individual
Prefix:MRS
First Name:DENA
Middle Name:MICHELLE
Last Name:WALD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:DENA
Other - Middle Name:MICHELLE
Other - Last Name:WALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:47 KINGSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1013
Mailing Address - Country:US
Mailing Address - Phone:617-969-0851
Mailing Address - Fax:
Practice Address - Street 1:47 KINGSWOOD RD
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-1013
Practice Address - Country:US
Practice Address - Phone:617-969-0851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12362225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist