Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 000712 | CT |
NPI | 1033644190 |
---|---|
Provider Name | Carole Maisel |
First Address | Easton, CT 06612-1423 |
Second Address | Easton, CT 06612-1423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2017 |
Last Update Date | 26/04/2017 |