Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 001455 | CT |
NPI | 1023544293 |
---|---|
Provider Name | Heather Nelson |
First Address | Vernon, CT 06066 |
Second Address | Vernon, CT 06066-4560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2017 |
Last Update Date | 10/05/2017 |