Provider Demographics
NPI:1669961710
Name:THIBODEAU, STEVEN ANTHONY (OTR/L)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANTHONY
Last Name:THIBODEAU
Suffix:
Gender:M
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 1:29 ATLANTA ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1702
Mailing Address - Country:US
Mailing Address - Phone:508-981-2994
Mailing Address - Fax:
Practice Address - Street 1:37 BIRCH ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-5501
Practice Address - Country:US
Practice Address - Phone:508-442-1829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist