Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1518114669 |
---|---|
Provider Name | Mrs. Carol Ann Ryall |
First Address | Groton, CT 06340-2717 |
Second Address | Groton, CT 06340-2717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2008 |
Last Update Date | 16/08/2013 |