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General NPI Number Information
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NPI Number | 1013782671
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Entity Type | Individual
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Provider Name | JENNIFER TRUONG
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Gender | Female
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Dates
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Enumeration Date | 11/22/2023
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Last Update Date | 11/22/2023
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Provider Practice Location Address
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Address Line | 43 RIDGE BLVD
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City | EAST GRANBY
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State | CT
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Zip | 06026-9302
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Country | US
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Telephone | 503-840-8045
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Fax |
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Provider Business Mailing Address
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Address Line | 555 WILLARD AVE
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City | HARTFORD
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State | CT
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Zip | 06111-2631
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Country | US
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Telephone | 860-666-6951
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 005496
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License Number State | CT
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