Provider Demographics
NPI:1770992125
Name:BLEAU, MONIQUE RENEE (OTR/L)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:RENEE
Last Name:BLEAU
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 1:100 CUMMINGS CTR STE 350G
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6136
Mailing Address - Country:US
Mailing Address - Phone:978-712-0003
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 350G
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6136
Practice Address - Country:US
Practice Address - Phone:978-712-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2019-09-26
Deactivation Date:2019-09-12
Deactivation Code:
Reactivation Date:2019-09-25
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
MA13285225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist