Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 007042 | CT |
NPI | 1043777568 |
---|---|
Provider Name | Cynthia Lynn Ouellette |
First Address | Plantsville, CT 06479-1017 |
Second Address | Kensington, CT 06037-2602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2019 |
Last Update Date | 21/02/2019 |