Healthcare Provider Details

I. General information

NPI: 1043637614
Provider Name (Legal Business Name): JESSICA MCGRATH MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 NICOLL ST # 1
NEW HAVEN CT
06511-2622
US

IV. Provider business mailing address

132 NICOLL ST # 1
NEW HAVEN CT
06511-2622
US

V. Phone/Fax

Practice location:
  • Phone: 860-483-1162
  • Fax:
Mailing address:
  • Phone: 860-483-1162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5728
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number3897
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: