Provider Demographics
NPI:1205407236
Name:IMAGO REHAB, INC
Entity type:Organization
Organization Name:IMAGO REHAB, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER, CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NUCKOLS
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, MOT, OTR
Authorized Official - Phone:617-671-0789
Mailing Address - Street 1:110 CANAL ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-3345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:617-250-8243
Practice Address - Street 1:110 CANAL ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:617-671-0789
Practice Address - Fax:617-250-8243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Single Specialty