Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 003357 | CT |
NPI | 1154654382 |
---|---|
Provider Name | Ms. Vivian Ivette Miranda |
First Address | Springfield, MA 01108-2617 |
Second Address | Hartford, CT 06102-8000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2009 |
Last Update Date | 04/09/2009 |