Healthcare Provider Details

I. General information

NPI: 1134060031
Provider Name (Legal Business Name): RYAN ROSKEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 ENSIGN DR STE B
AVON CT
06001-3773
US

IV. Provider business mailing address

24 PHEASANT DR
WESTFIELD MA
01085-5144
US

V. Phone/Fax

Practice location:
  • Phone: 860-404-2461
  • Fax:
Mailing address:
  • Phone: 413-579-1890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number6861
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: