| NPI | 1124118229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN M HICKEY Provider Enrollment Manager 617-355-4956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| 363AS0400X Physician Assistant, Surgical | |
| 103TC0700X Psychologist, Clinical | |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology | |
| 231H00000X Audiologist | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2025-12-11 |