Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 979 | CT |
Y | 222Z00000X | Podiatrist | 979 | CT |
N | 111NR0200X | Radiology | 979 | CT |
N | 213ER0200X | Radiology | 979 | CT |
N | 213ES0131X | Foot Surgery | 979 | CT |
N | 225000000X | Orthotic Fitter | 979 | CT |
NPI | 1083000269 |
---|---|
Provider Name | Jamie Anthony Otfinoski |
First Address | Bethel, CT 06801-1877 |
Second Address | Bethel, CT 06801-1877 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 09/05/2018 |