Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 001594 | CT |
NPI | 1013580315 |
---|---|
Provider Name | Theresa Maureen Grey |
First Address | Wolcott, CT 06716-2123 |
Second Address | Wolcott, CT 06716-2123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2021 |
Last Update Date | 23/07/2021 |