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NPI Code Detail

MEDICARE: DIANE M PHIPPS OT ASSISTANT

MEDICARE: DIANE M PHIPPS OT ASSISTANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant000452CT

General Provider Information

NPI Number : 1790031730
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE M PHIPPS OT ASSISTANT
Provider Business Mailing Address
First Line : 50 BEACH RD
Second Line :
City : WOLCOTT
State : CT
Zip : 06716-1902
Country : US
Telephone Number : 860-879-8066
Fax Number :
Provider Business Practice Location Address
First Line : 50 BEACH RD
Second Line :
City : WOLCOTT
State : CT
Zip : 06716-1902
Country : US
Telephone Number : 860-879-8066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2012
Last Update Date : 07/27/2012

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