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General NPI Number Information
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NPI Number | 1093340853
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Entity Type | Individual
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Provider Name | KELLY DIONNE
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Gender | Female
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 1360 TORRINGFORD ST
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City | TORRINGTON
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State | CT
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Zip | 06790-3140
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Country | US
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Telephone | 860-489-1008
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Fax |
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Provider Business Mailing Address
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Address Line | 66 STARKWEATHER HILL RD
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City | WORTHINGTON
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State | MA
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Zip | 01098-9607
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Country | US
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Telephone | 937-214-7667
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 4557
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License Number State | MA
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