Healthcare Provider Details

I. General information

NPI: 1114484987
Provider Name (Legal Business Name): OUTPATIENT MOBILE SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LABBY RD
NORTH GROSVENORDALE CT
06255-1247
US

IV. Provider business mailing address

113 LABBY RD
NORTH GROSVENORDALE CT
06255-1247
US

V. Phone/Fax

Practice location:
  • Phone: 607-278-6209
  • Fax:
Mailing address:
  • Phone: 860-497-0239
  • Fax: 860-497-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. TANYA LEE CLARK
Title or Position: INCORPORATOR
Credential: OTD, OTR/L
Phone: 860-497-0239