Healthcare Provider Details

I. General information

NPI: 1780515346
Provider Name (Legal Business Name): JESSICA FOLLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MAIN ST
GLASTONBURY CT
06033-2218
US

IV. Provider business mailing address

5 PEAR ORCHARD RD
PORTLAND CT
06480-4606
US

V. Phone/Fax

Practice location:
  • Phone: 860-430-1762
  • Fax:
Mailing address:
  • Phone: 860-471-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number006517
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: