Provider Demographics
NPI:1710311436
Name:LIGHTHOUSE: PEDIATRIC OCCUPATIONAL THERAPY SERVICES
Entity Type:Organization
Organization Name:LIGHTHOUSE: PEDIATRIC OCCUPATIONAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PROCOPIO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:781-985-4678
Mailing Address - Street 1:553 HAVERHILL ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-1161
Mailing Address - Country:US
Mailing Address - Phone:781-985-4678
Mailing Address - Fax:
Practice Address - Street 1:553 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-1161
Practice Address - Country:US
Practice Address - Phone:781-985-4678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2109225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty