Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 001264 | CT |
NPI | 1023376639 |
---|---|
Provider Name | Kara Nicole Shemo |
First Address | Wethersfield, CT 06109-1204 |
Second Address | Wethersfield, CT 06109-1204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2012 |
Last Update Date | 02/05/2012 |