Basic Information
| Provider Information | |||||||||
| NPI: | 1245358571 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESIS ELDERCARE REHAB SRVCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 N PEMBROKE RD | ||||||||
| Address2: | |||||||||
| City: | EPSOM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032344010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037369444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 480 DONALD ST | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031105945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036274147 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SEVERINO | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 6037369444 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | OT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1373 | NH | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.