Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 001917 | CT |
NPI | 1023692373 |
---|---|
Provider Name | Mrs. Emanuela Natasha Dacruz |
First Address | Shelton, CT 06484-2732 |
Second Address | Woodbridge, CT 06525-2206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2021 |
Last Update Date | 11/05/2021 |