Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XM0800X | Mental Health | 3897 | CT |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 5728 | AZ |
NPI | 1043637614 |
---|---|
Provider Name | Jessica Mcgrath |
First Address | New Haven, CT 06511-2622 |
Second Address | New Haven, CT 06511-2622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2014 |
Last Update Date | 21/03/2014 |