Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 002950 | CO |
NPI | 1063409399 |
---|---|
Provider Name | Jan M. Soares |
First Address | Glastonbury, CT 06033-1208 |
Second Address | Glastonbury, CT 06033-1208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 13/09/2016 |