Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 003855 | CT |
NPI | 1003209420 |
---|---|
Provider Name | Mrs. Christine Pender |
First Address | Rocky Hill, CT 06067-1221 |
Second Address | Rocky Hill, CT 06067-1221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2015 |
Last Update Date | 10/03/2015 |