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General NPI Number Information
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NPI Number | 1265103386
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Entity Type | Individual
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Provider Name | STEVEN FREDRICK NACKLEY OTR/L
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Gender | Male
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 45 MERIDEN AVE
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City | SOUTHINGTON
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State | CT
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Zip | 06489-3214
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Country | US
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Telephone | 860-621-9559
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Fax |
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Provider Business Mailing Address
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Address Line | 366 PARK RD APT A1
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1959
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Country | US
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Telephone | 860-798-5310
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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 | 4495
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License Number State | CT
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