Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 001434 | CT |
NPI | 1003416835 |
---|---|
Provider Name | Colleen Hermann |
First Address | Naugatuck, CT 06770-2741 |
Second Address | Shelton, CT 06484-4810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2020 |
Last Update Date | 30/10/2020 |