Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 001146 | CT |
NPI | 1720302995 |
---|---|
Provider Name | Shirley Ann Rafferty |
First Address | Thompson, CT 06277-2509 |
Second Address | Thompson, CT 06277-2509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2010 |
Last Update Date | 17/03/2010 |