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General NPI Number Information
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NPI Number | 1063069029
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Entity Type | Organization
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Legal Business Name | DTG GROUP LLC
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Dates
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Enumeration Date | 08/23/2019
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 92 BROOKSIDE RD STE 103
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City | WATERBURY
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State | CT
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Zip | 06708-1402
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Country | US
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Telephone | 203-578-7225
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Fax |
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Provider Business Mailing Address
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Address Line | 92 BROOKSIDE RD STE 103
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City | WATERBURY
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State | CT
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Zip | 06708-1402
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Country | US
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Telephone | 203-578-7225
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | CHAIM LASSER
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Credential |
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Telephone | 203-578-7225
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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 |
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License Number State |
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