Healthcare Provider Details

I. General information

NPI: 1215054150
Provider Name (Legal Business Name): LISA DAUPHINAIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WINDSOR AVE
PLAINFIELD CT
06374-1036
US

IV. Provider business mailing address

23 WAUREGAN RD
DANIELSON CT
06239-3714
US

V. Phone/Fax

Practice location:
  • Phone: 860-564-4081
  • Fax:
Mailing address:
  • Phone: 860-774-8129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number00846
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: