Basic Information
Provider Information | |||||||||
NPI: | 1275767238 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | D & H THERAPY ASSOCIATES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ONE BUTLER AVENUE PROVIDENCE RI 02906 | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 100 SMITHFIELD AVE | ||||||||
Address2: |   | ||||||||
City: | PAWTUCKET | ||||||||
State: | RI | ||||||||
PostalCode: | 028603497 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4017259666 | ||||||||
FaxNumber: | 4017272750 | ||||||||
Practice Location | |||||||||
Address1: | 1 BUTLER AVE | ||||||||
Address2: |   | ||||||||
City: | PROVIDENCE | ||||||||
State: | RI | ||||||||
PostalCode: | 029065178 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4012735031 | ||||||||
FaxNumber: | 4012735103 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/06/2009 | ||||||||
LastUpdateDate: | 05/06/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HAVUNEN | ||||||||
AuthorizedOfficialFirstName: | KIM | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 4017259600 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | 709003141 | RI | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
No ID Information.