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General NPI Number Information
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NPI Number | 1285149674
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Entity Type | Individual
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Provider Name | MARILYN A BAGLEY
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Gender | Female
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 130 LOOMIS DR
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2037
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Country | US
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Telephone | 860-521-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 417 S MAIN ST
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City | TERRYVILLE
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State | CT
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Zip | 06786-6809
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Country | US
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Telephone | 413-519-8898
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 00026
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License Number State | CT
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