Provider Demographics
NPI:1013332386
Name:GROTON INTEGRATED THERAPIES
Entity Type:Organization
Organization Name:GROTON INTEGRATED THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HAMILTON-GOSCOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:978-448-4001
Mailing Address - Street 1:497 MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1298
Mailing Address - Country:US
Mailing Address - Phone:978-448-4001
Mailing Address - Fax:978-448-4002
Practice Address - Street 1:497 MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1298
Practice Address - Country:US
Practice Address - Phone:978-448-4001
Practice Address - Fax:978-448-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty