Provider Demographics
NPI:1578225157
Name:AT HOME 4 LIFE LLC
Entity Type:Organization
Organization Name:AT HOME 4 LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROTTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-971-8733
Mailing Address - Street 1:26 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2445
Mailing Address - Country:US
Mailing Address - Phone:978-971-8733
Mailing Address - Fax:
Practice Address - Street 1:26 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2445
Practice Address - Country:US
Practice Address - Phone:978-971-8733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty