Provider Demographics
NPI:1710618509
Name:BOYLE, MARY ELLEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:BOYLE
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 1:75 OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2607
Mailing Address - Country:US
Mailing Address - Phone:781-662-2732
Mailing Address - Fax:
Practice Address - Street 1:75 OAKLAND ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2607
Practice Address - Country:US
Practice Address - Phone:781-662-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty