Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 000250 | CT |
NPI | 1003280785 |
---|---|
Provider Name | Kristen Chipman |
First Address | Bristol, CT 06010-3180 |
Second Address | Bristol, CT 06010-5531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2015 |
Last Update Date | 18/11/2015 |