Provider Demographics
NPI:1821272220
Name:PISANO, BETH VICTORIA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:VICTORIA
Last Name:PISANO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:BETH
Other - Middle Name:VICTORIA
Other - Last Name:WOLONSAVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:111 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1827
Mailing Address - Country:US
Mailing Address - Phone:978-921-1182
Mailing Address - Fax:978-921-2982
Practice Address - Street 1:111 DODGE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1827
Practice Address - Country:US
Practice Address - Phone:978-921-1182
Practice Address - Fax:978-921-2982
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6984225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist