Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2632 | CT |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 2632 | CT |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 2632 | CT |
NPI | 1639561483 |
---|---|
Provider Name | Kimberly Brunnock |
First Address | Berlin, CT 06037-1395 |
Second Address | Berlin, CT 06037-1395 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2015 |
Last Update Date | 02/03/2015 |