Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1396210308 |
---|---|
Provider Name | Clancy James Purcell |
First Address | Shelton, CT 06484-1844 |
Second Address | Shelton, CT 06484-1844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2018 |
Last Update Date | 05/10/2018 |