Provider Demographics
NPI:1679794424
Name:WIATROWSKI, NATALIE LELAND (OTRL)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:LELAND
Last Name:WIATROWSKI
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:E
Other - Last Name:LELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:18 BOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878
Mailing Address - Country:US
Mailing Address - Phone:401-624-1978
Mailing Address - Fax:
Practice Address - Street 1:SOMERSET RIDGE CENTER
Practice Address - Street 2:455 BRAYTON AVE
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02626
Practice Address - Country:US
Practice Address - Phone:508-679-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7833225X00000X
RIOT00776225X00000X
VA0119003402225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist