Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 002096 | CT |
NPI | 1235474917 |
---|---|
Provider Name | Mrs. Jennifer M Wilson |
First Address | Stamford, CT 06902 |
Second Address | Stamford, CT 06902-1811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2012 |
Last Update Date | 06/12/2012 |