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General NPI Number Information
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NPI Number | 1396235966
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Entity Type | Individual
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Provider Name | JENNIFER ANN BARTISS-EARLEY OT/L, CHT
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Gender | Female
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 12 BRICK WALK LN
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City | FARMINGTON
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State | CT
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Zip | 06032-2368
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Country | US
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Telephone | 203-376-5646
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Fax |
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Provider Business Mailing Address
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Address Line | 74 S WASHINGTON ST
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City | PLAINVILLE
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State | CT
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Zip | 06062-2757
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Country | US
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Telephone | 203-376-5646
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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 | 001659
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 001659
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License Number State | CT
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