| NPI | 1124670625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA A FERRIS Program Manager 860-489-1328 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics |
| 225XP0200X Occupational Therapist, Pediatrics | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2019-07-15 |