Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 002169 | CT |
NPI | 1497875645 |
---|---|
Provider Name | Mrs. Heather Dupree Vines-Dubose |
First Address | Bridgeport, CT 06606-1949 |
Second Address | Norwalk, CT 06850-3302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 11/12/2012 |