Provider Demographics
NPI:1538348925
Name:LOUIS B. COIRO, INC.
Entity type:Organization
Organization Name:LOUIS B. COIRO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-851-8768
Mailing Address - Street 1:885 MAIN ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1800
Mailing Address - Country:US
Mailing Address - Phone:978-851-8768
Mailing Address - Fax:978-851-8606
Practice Address - Street 1:885 MAIN ST
Practice Address - Street 2:UNIT 4
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1800
Practice Address - Country:US
Practice Address - Phone:978-851-8768
Practice Address - Fax:978-851-8606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUIS B. COIRO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-01
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3610225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAOG0003OtherBCBS
1249180001Medicare NSC