Provider Demographics
NPI:1417518515
Name:GREGOIRE, AMY (COTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GREGOIRE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7C VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:WEST YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-8226
Mailing Address - Country:US
Mailing Address - Phone:508-360-3827
Mailing Address - Fax:
Practice Address - Street 1:119 WAREHAM RD UNIT 107
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-1178
Practice Address - Country:US
Practice Address - Phone:508-748-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA900960125224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant