Healthcare Provider Details

I. General information

NPI: 1558452896
Provider Name (Legal Business Name): TERESA MARTIN DOTSON R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 TORRINGTON AVE
COLLINSVILLE CT
06019-3326
US

IV. Provider business mailing address

109 TORRINGTON AVE
COLLINSVILLE CT
06019-3326
US

V. Phone/Fax

Practice location:
  • Phone: 860-693-0672
  • Fax:
Mailing address:
  • Phone: 860-693-0672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000196
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: