Provider Demographics
NPI:1902860257
Name:CARNEY, GRETCHEN L (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:GRETCHEN
Middle Name:L
Last Name:CARNEY
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:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-0030
Mailing Address - Country:US
Mailing Address - Phone:781-573-1686
Mailing Address - Fax:781-573-1696
Practice Address - Street 1:15 ROCHE BROS. WAY
Practice Address - Street 2:
Practice Address - City:NORTH EASON
Practice Address - State:MA
Practice Address - Zip Code:02356
Practice Address - Country:US
Practice Address - Phone:781-573-1686
Practice Address - Fax:781-573-1696
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9198225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69747OtherMEDICARE