1871880450 NPI number — MRS. JENNIFER MARIE RIOPELLE OTR/L

Table of content: DR. NATHANIEL RYAN O'BEAR DBA, BCBA (NPI 1104566603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871880450 NPI number — MRS. JENNIFER MARIE RIOPELLE OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIOPELLE
Provider First Name:
JENNIFER
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRASSO
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871880450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74 BRIDGE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-923-4410
Provider Business Mailing Address Fax Number:
617-923-0468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74 BRIDGE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-969-4410
Provider Business Practice Location Address Fax Number:
617-923-0468
Provider Enumeration Date:
07/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  10353 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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