Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 000757 | CT |
NPI | 1144556465 |
---|---|
Provider Name | Mrs. Jennifer Peterson |
First Address | Fairfield, CT 06825-1078 |
Second Address | Fairfield, CT 06825-1078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2009 |
Last Update Date | 21/10/2009 |