| NPI | 1801279492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AILENE DEBRA TISSER Co Owner 203-969-6431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MA 11053) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 10221) |
| 174400000X Specialist (Licence: MA 10846) | |
| 174400000X Specialist (Licence: MA 9353) | |
| 225X00000X Occupational Therapist (Licence: MA 10221) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2015-07-01 |