Provider Demographics
NPI:1902042625
Name:NDEGWA, SERAPHINE N (OCC THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:SERAPHINE
Middle Name:N
Last Name:NDEGWA
Suffix:
Gender:F
Credentials:OCC THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 OAK ST EXT APT 103
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1126
Mailing Address - Country:US
Mailing Address - Phone:617-595-0518
Mailing Address - Fax:
Practice Address - Street 1:50 OAK ST EXT APT 103
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1126
Practice Address - Country:US
Practice Address - Phone:617-595-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5617225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist