Healthcare Provider Details

I. General information

NPI: 1457140550
Provider Name (Legal Business Name): INNER REACH THERAPEUTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 DUDLEY TOWN RD
WINDSOR CT
06095-2640
US

IV. Provider business mailing address

255 DUDLEY TOWN RD
WINDSOR CT
06095-2640
US

V. Phone/Fax

Practice location:
  • Phone: 860-752-4996
  • Fax:
Mailing address:
  • Phone: 860-752-4996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA MARRIS
Title or Position: OWNER
Credential: OTR/L
Phone: 860-752-4996