Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 4617-026 | WI |
N | 225XH1200X | Occupational Therapist - Hand | 109297 | TX |
N | 225XH1200X | Occupational Therapist - Hand | 4617-026 | WI |
NPI | 1023156759 |
---|---|
Provider Name | Mrs. Mirka Normand |
First Address | Groton, CT 06340-3268 |
Second Address | Groton, CT 06340-3268 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 15/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41064900 | (05) | WI |