Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 003586 | CT |
N | 225X00000X | Occupational Therapist | 009947-1 | NY |
NPI | 1003912825 |
---|---|
Provider Name | Ms. Lynn Beard |
First Address | Prospect, CT 06712-1484 |
Second Address | Prospect, CT 06712-1223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 13/04/2011 |