Provider Demographics
NPI:1871216705
Name:DEGRASSE, ISABELLA MARIA
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:MARIA
Last Name:DEGRASSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MURIEL AVE # 1
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-1426
Mailing Address - Country:US
Mailing Address - Phone:491-548-0441
Mailing Address - Fax:
Practice Address - Street 1:28 MURIEL AVE # 1
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-1426
Practice Address - Country:US
Practice Address - Phone:491-548-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist