Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 002956 | CT |
NPI | 1164988242 |
---|---|
Provider Name | Meredith Whiting |
First Address | Torrington, CT 06790-4947 |
Second Address | Torrington, CT 06790-4947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2019 |
Last Update Date | 14/02/2019 |