Provider Demographics
NPI: | 1659521284 |
---|---|
Name: | SAFE AT HOME |
Entity Type: | Organization |
Organization Name: | SAFE AT HOME |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DOREEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KRUGER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OTR/L |
Authorized Official - Phone: | 413-297-4057 |
Mailing Address - Street 1: | 10 BIRCHWOOD DR |
Mailing Address - Street 2: | |
Mailing Address - City: | HUNTINGTON |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 01050-9623 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 413-297-4057 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 10 BIRCHWOOD DR |
Practice Address - Street 2: | |
Practice Address - City: | HUNTINGTON |
Practice Address - State: | MA |
Practice Address - Zip Code: | 01050-9623 |
Practice Address - Country: | US |
Practice Address - Phone: | 413-297-4057 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-09-18 |
Last Update Date: | 2008-09-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 6487 | 225X00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty |