Provider Demographics
NPI:1659906915
Name:PROULX, GRETCHEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:PROULX
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CLARKE CT # 2
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2619
Mailing Address - Country:US
Mailing Address - Phone:401-439-3723
Mailing Address - Fax:
Practice Address - Street 1:18 CLARKE CT # 2
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2619
Practice Address - Country:US
Practice Address - Phone:401-439-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11446225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty