Provider Demographics
NPI:1740524206
Name:HETU, RUTH ELIZABETH (COTA)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ELIZABETH
Last Name:HETU
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75B HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330-1077
Mailing Address - Country:US
Mailing Address - Phone:508-455-7070
Mailing Address - Fax:
Practice Address - Street 1:75B HIGH ST
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MA
Practice Address - Zip Code:02330-1077
Practice Address - Country:US
Practice Address - Phone:508-455-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2980224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant