Provider Demographics
NPI:1215168083
Name:LEVESQUE, CAROLYN M (OTRL)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:M
Other - Last Name:FERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:180 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-2468
Mailing Address - Country:US
Mailing Address - Phone:508-380-6873
Mailing Address - Fax:
Practice Address - Street 1:25 STONEHAVEN DR
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190
Practice Address - Country:US
Practice Address - Phone:781-337-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9717225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist