Healthcare Provider Details

I. General information

NPI: 1235303553
Provider Name (Legal Business Name): ADVANCED THERAPY SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SILAS DEANE HWY
WETHERSFIELD CT
06109-2134
US

IV. Provider business mailing address

465 SILAS DEANE HWY
WETHERSFIELD CT
06109-2134
US

V. Phone/Fax

Practice location:
  • Phone: 860-721-9999
  • Fax: 860-721-9903
Mailing address:
  • Phone: 860-721-9999
  • Fax: 860-721-9903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number002805
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number004091
License Number StateCT

VIII. Authorized Official

Name: MISS MARIE LOUISE MANCINI
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 860-721-9999