Provider Demographics
NPI:1386125417
Name:HAINES GAUTHIER, LIV HELENA (MS OT/L)
Entity type:Individual
Prefix:
First Name:LIV
Middle Name:HELENA
Last Name:HAINES GAUTHIER
Suffix:
Gender:F
Credentials:MS OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:74 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-3806
Mailing Address - Country:US
Mailing Address - Phone:508-789-4087
Mailing Address - Fax:
Practice Address - Street 1:50 INDIAN NECK RD
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2174
Practice Address - Country:US
Practice Address - Phone:508-295-6264
Practice Address - Fax:508-295-3484
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7956225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist