Provider Demographics
NPI:1417406133
Name:BIRON, ADAM (COTA/L)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BIRON
Suffix:
Gender:M
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 1:215 BANK STREET EXT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1177
Mailing Address - Country:US
Mailing Address - Phone:347-525-7259
Mailing Address - Fax:
Practice Address - Street 1:215 BANK STREET EXT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1177
Practice Address - Country:US
Practice Address - Phone:347-525-7259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT073.0080143224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant