Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023517042 |
---|---|
Provider Name | Xiomara Pais |
First Address | Waterbury, CT 06706-2143 |
Second Address | Trumbull, CT 06611-2075 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2018 |
Last Update Date | 05/02/2018 |