Provider Demographics
NPI:1427200559
Name:BALDASSARRE, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BALDASSARRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 OXFORD ST N
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-1143
Mailing Address - Country:US
Mailing Address - Phone:508-832-2459
Mailing Address - Fax:
Practice Address - Street 1:88 MASONIC HOME RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-1394
Practice Address - Country:US
Practice Address - Phone:508-434-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1524225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist