=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306308952
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERESA LOHR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2019
-----------------------------------------------------
Last Update Date | 04/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1261 S MAIN ST
-----------------------------------------------------
City | PLANTSVILLE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06479-1750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-628-9000
-----------------------------------------------------
Fax | 860-628-3071
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 LORRAINE ST
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06105-2241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-323-9574
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 5021
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------