Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0200X | Occupational Therapist - Pediatrics | 002257 | CT |
NPI | 1003944091 |
---|---|
Provider Name | Marisa Love |
First Address | Bridgeport, CT 06604-2300 |
Second Address | Fairfield, CT 06825-3506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 08/07/2007 |