Provider Demographics
NPI:1801377569
Name:MUNCHERIAN, IRENE (OTR/L)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:MUNCHERIAN
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 1:4 BRADFORD RD APT 1
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3310
Mailing Address - Country:US
Mailing Address - Phone:978-621-3177
Mailing Address - Fax:
Practice Address - Street 1:123 HIGH ST
Practice Address - Street 2:
Practice Address - City:TOPSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01983-1921
Practice Address - Country:US
Practice Address - Phone:978-887-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A