Healthcare Provider Details

I. General information

NPI: 1902715576
Provider Name (Legal Business Name): VALERIE JORDAN GIMLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 SEYMOUR AVE
DERBY CT
06418-1336
US

IV. Provider business mailing address

600 WASHINGTON AVE APT B7
NORTH HAVEN CT
06473-1145
US

V. Phone/Fax

Practice location:
  • Phone: 203-732-7445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6636
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: