Provider Demographics
NPI:1821833922
Name:LAURITA, MARY CAROLINE (OT, OTD, OTR)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CAROLINE
Last Name:LAURITA
Suffix:
Gender:F
Credentials:OT, OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HARVARD ST UNIT 17
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6259
Mailing Address - Country:US
Mailing Address - Phone:973-590-6286
Mailing Address - Fax:
Practice Address - Street 1:607 NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1322
Practice Address - Country:US
Practice Address - Phone:781-245-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15372225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist