Provider Demographics
NPI:1013944388
Name:RADVILLE, TRUDY ROSE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TRUDY
Middle Name:ROSE
Last Name:RADVILLE
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 1:11 BETHANY LN
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-1073
Mailing Address - Country:US
Mailing Address - Phone:508-758-6494
Mailing Address - Fax:
Practice Address - Street 1:940 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5596
Practice Address - Country:US
Practice Address - Phone:508-583-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1913225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist