Provider Demographics
NPI:1851572689
Name:BRAYTON-CHUNG, ABIGAIL MAREE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MAREE
Last Name:BRAYTON-CHUNG
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 1:22 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-3924
Mailing Address - Country:US
Mailing Address - Phone:720-381-7595
Mailing Address - Fax:
Practice Address - Street 1:465 WAVERLEY OAKS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8438
Practice Address - Country:US
Practice Address - Phone:781-894-6564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10664225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist