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General NPI Number Information
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NPI Number | 1447818588
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Entity Type | Individual
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Provider Name | ANNE MARIE WALLNER-GREEN OTR
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Gender | Female
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 2021 ALBANY AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06117-2789
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Country | US
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Telephone | 860-570-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 43 BANCROFT LN
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2464
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Country | US
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Telephone | 860-995-3530
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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 | 004630
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License Number State | CT
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