Provider Demographics
NPI:1710171723
Name:MACKINTOSH, ARICE STAEB (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ARICE
Middle Name:STAEB
Last Name:MACKINTOSH
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 1:517 IDEAL LN
Mailing Address - Street 2:UNIT 206
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-2894
Mailing Address - Country:US
Mailing Address - Phone:413-583-7264
Mailing Address - Fax:413-583-4762
Practice Address - Street 1:517 IDEAL LN
Practice Address - Street 2:UNIT 206
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-2894
Practice Address - Country:US
Practice Address - Phone:413-583-7264
Practice Address - Fax:413-583-4762
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6975225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist