Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 4896 | CT |
N | 225XE0001X | Environmental Modification | 4896 | CT |
N | 225XM0800X | Mental Health | 4896 | CT |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 4896 | CT |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4896 | CT |
NPI | 1497429088 |
---|---|
Provider Name | Michael Della Volpe |
First Address | Enfield, CT 06082-4752 |
Second Address | Enfield, CT 06082-4752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2021 |
Last Update Date | 06/08/2021 |