Basic Information
| Provider Information | |||||||||
| NPI: | 1437401395 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROCKEFELLER | ||||||||
| FirstName: | EVAN | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 EASTBROOK RD | ||||||||
| Address2: | |||||||||
| City: | DEDHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020262075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813024600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11 CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | CHELSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021502812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178892523 | ||||||||
| FaxNumber: | 6178892524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2012 | ||||||||
| LastUpdateDate: | 01/04/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 10700 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.