Provider Demographics
NPI:1639165806
Name:NOVACARE REHABILITATION
Entity Type:Organization
Organization Name:NOVACARE REHABILITATION
Other - Org Name:S.T.A.R.T. INC. DBA NOVACARE REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANON
Authorized Official - Middle Name:E
Authorized Official - Last Name:VALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:413-733-3939
Mailing Address - Street 1:68 EDWARD DR
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1006
Mailing Address - Country:US
Mailing Address - Phone:413-231-2947
Mailing Address - Fax:
Practice Address - Street 1:3550 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1089
Practice Address - Country:US
Practice Address - Phone:413-733-3939
Practice Address - Fax:413-733-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8681225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0704962Medicaid