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General NPI Number Information
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NPI Number | 1144616772
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Entity Type | Individual
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Provider Name | BETH HUMPHREYS
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Gender | Female
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Dates
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Enumeration Date | 04/10/2015
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Last Update Date | 04/10/2015
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Provider Practice Location Address
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Address Line | 59 HARRINGTON CT
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City | COLCHESTER
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State | CT
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Zip | 06415-1207
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Country | US
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Telephone | 860-537-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 95 SENATE BROOK DR
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City | AMSTON
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State | CT
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Zip | 06231-1520
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Country | US
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Telephone | 860-228-8201
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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 | 0527
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License Number State | CT
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