Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 001094 | CT |
NPI | 1275285009 |
---|---|
Provider Name | Ann Olansen Roth |
First Address | Glastonbury, CT 06033-4380 |
Second Address | Glastonbury, CT 06033-4380 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2022 |
Last Update Date | 24/01/2022 |