Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 002048 | CT |
NPI | 1902218647 |
---|---|
Provider Name | Mr. John Feiler |
First Address | Fairfield, CT 06825 |
Second Address | Fairfield, CT 06825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2014 |
Last Update Date | 29/05/2014 |