Provider Demographics
NPI:1497066427
Name:SKINNER, JUDITH (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CHAPMAN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2093
Mailing Address - Country:US
Mailing Address - Phone:781-821-9955
Mailing Address - Fax:781-821-9950
Practice Address - Street 1:500 CHAPMAN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2093
Practice Address - Country:US
Practice Address - Phone:781-821-9955
Practice Address - Fax:781-821-9950
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9443225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA616937OtherTUFTS