Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 5375 | CT |
NPI | 1245860170 |
---|---|
Provider Name | Kristin Ladd Kolack |
First Address | Southbury, CT 06488-4652 |
Second Address | Enfield, CT 06082-3739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2020 |
Last Update Date | 20/01/2020 |