Provider Demographics
NPI:1962610188
Name:DEELEY, KATHERINE BUSSELL (OTRL)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:BUSSELL
Last Name:DEELEY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:BUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:61 KENNEY ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-4447
Mailing Address - Country:US
Mailing Address - Phone:781-444-5996
Mailing Address - Fax:
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-3258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5495225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist