Provider Demographics
NPI:1659698454
Name:DAVID OUELLETTE OF WAKEFIELD MA
Entity Type:Organization
Organization Name:DAVID OUELLETTE OF WAKEFIELD MA
Other - Org Name:BRIGHTSTAR OF WAKEFIELD MA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:OUELLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-246-8706
Mailing Address - Street 1:599 NORTH AVE
Mailing Address - Street 2:DOOR #9
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1648
Mailing Address - Country:US
Mailing Address - Phone:781-246-8706
Mailing Address - Fax:339-219-6453
Practice Address - Street 1:599 NORTH AVE
Practice Address - Street 2:DOOR #9
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1648
Practice Address - Country:US
Practice Address - Phone:781-246-8706
Practice Address - Fax:339-219-6453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8049251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health