Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 003587 | CT |
NPI | 1023449345 |
---|---|
Provider Name | Kiersten Belanger |
First Address | Newington, CT 06111-4416 |
Second Address | Newington, CT 06111-4416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2013 |
Last Update Date | 12/12/2013 |