Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 4975 | CT |
NPI | 1649818709 |
---|---|
Provider Name | Megan Shepard |
First Address | Southbury, CT 06488-1267 |
Second Address | Southbury, CT 06488-1267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2019 |
Last Update Date | 19/12/2019 |