Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 003405 | CT |
NPI | 1689833345 |
---|---|
Provider Name | Stephani Shivers |
First Address | West Hartford, CT 06117-1644 |
Second Address | Plantsville, CT 06479-1750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2008 |
Last Update Date | 24/06/2014 |