Provider Demographics
NPI:1265881247
Name:PARKER, CARDINAL
Entity type:Individual
Prefix:
First Name:CARDINAL
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 MAIN ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:INDIAN ORCHARD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1228
Mailing Address - Country:US
Mailing Address - Phone:413-657-7425
Mailing Address - Fax:413-783-8965
Practice Address - Street 1:529 MAIN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:INDIAN ORCHARD
Practice Address - State:MA
Practice Address - Zip Code:01151-1228
Practice Address - Country:US
Practice Address - Phone:413-657-7425
Practice Address - Fax:413-783-8965
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5622225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist