Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 000816 | CT |
NPI | 1588153555 |
---|---|
Provider Name | Laureanne M Eastman |
First Address | Danielson, CT 06239-3726 |
Second Address | Danielson, CT 06239-3726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2018 |
Last Update Date | 06/05/2018 |