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General NPI Number Information
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NPI Number | 1093523912
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Entity Type | Organization
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Legal Business Name | ROAD TO INDEPENDENCE
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 769 NEWFIELD ST STE 4
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City | MIDDLETOWN
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State | CT
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Zip | 06457-1846
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Country | US
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Telephone | 203-376-6640
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Fax |
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Provider Business Mailing Address
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Address Line | 92 KIMBERLY RD
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City | EAST GRANBY
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State | CT
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Zip | 06026-9540
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Country | US
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Telephone | 203-376-6640
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LYNN A COALSON
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Credential | OTR/L, M.ED., CBT
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Telephone | 203-376-6640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number |
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License Number State |
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