Provider Demographics
NPI:1417118936
Name:WHITFORD, THERESA ELLEN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ELLEN
Last Name:WHITFORD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:ELLEN
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:65 UNION ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2523
Mailing Address - Country:US
Mailing Address - Phone:617-966-3367
Mailing Address - Fax:
Practice Address - Street 1:10 BELLAMY ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1502
Practice Address - Country:US
Practice Address - Phone:617-782-8113
Practice Address - Fax:617-779-4033
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2813224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant