Provider Demographics
NPI:1659658334
Name:BAIN, PATRICE D (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:D
Last Name:BAIN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 POST OFFICE SQ
Mailing Address - Street 2:SUITE 3600
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-2106
Mailing Address - Country:US
Mailing Address - Phone:866-590-0011
Mailing Address - Fax:888-445-3937
Practice Address - Street 1:1 POST OFFICE SQ
Practice Address - Street 2:SUITE 3600
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-2106
Practice Address - Country:US
Practice Address - Phone:866-590-0011
Practice Address - Fax:888-445-3937
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7552225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision