Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 001763 | CT |
NPI | 1023666831 |
---|---|
Provider Name | Victoria Gilliard |
First Address | New London, CT 06320-5146 |
Second Address | Mystic, CT 06355-1958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2019 |
Last Update Date | 27/08/2019 |