Provider Demographics
NPI:1851438865
Name:GARDINER, PAULINE G (OTR)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:G
Last Name:GARDINER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MENOTOMY ROCKS DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-7807
Mailing Address - Country:US
Mailing Address - Phone:781-648-7111
Mailing Address - Fax:
Practice Address - Street 1:11 MENOTOMY ROCKS DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-7807
Practice Address - Country:US
Practice Address - Phone:781-648-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6039225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6039OtherSTATE OT LICENSE