Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 004454 | CT |
NPI | 1184179566 |
---|---|
Provider Name | Maureen Mcnally |
First Address | Bridgeport, CT 06606-4263 |
Second Address | Bridgeport, CT 06606-4263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2016 |
Last Update Date | 13/09/2016 |