Provider Demographics
NPI:1902036817
Name:SMALL, EILEEN M (PTA)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:M
Last Name:SMALL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MASSASOIT AVE
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045-2536
Mailing Address - Country:US
Mailing Address - Phone:781-367-0255
Mailing Address - Fax:
Practice Address - Street 1:42 MASSASOIT AVE
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:MA
Practice Address - Zip Code:02045-2536
Practice Address - Country:US
Practice Address - Phone:781-367-0255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8003225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant