Provider Demographics
NPI:1417355215
Name:BOURGEOIS, KERRY JEAN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:JEAN
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 LINDALL ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2125
Mailing Address - Country:US
Mailing Address - Phone:978-777-3740
Mailing Address - Fax:
Practice Address - Street 1:90 LINDALL ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2125
Practice Address - Country:US
Practice Address - Phone:978-777-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3231224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant